DOCUMENT RESUME HE 008 013 Elder, ,lerry 0.;vAnd Others -j … · 2014. 1. 27. · TABLE OF CONTENTS PREFACE a, iii INTRODUCTION 1 Historical Review 1 Administrator's Training Project

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HE 008 013

Elder, ,lerry 0.;vAnd OthersEducation of Health Service Administrators in -anInterdisciplinary Model..Position Paper. tevisela,Edition.Oregon Univ., Portland.Health Services Administration (DHEVEHS),.Bockville,Md. Bureau-oUsCommunity Health Services.MCT-001012'Jan 7192p.

M University of Oregon Health Sciences Center,Portland, Oregon

MF-S0.83 BC-$4.0 Pins Postage.*Administrative Personnel; Administrator Background;Administrator Responsibility; Curriculum;*Educational Objectives; *Health OccupationsEducation; *Health Services; *Higher Education;*Interdisciplinary Approach; Mental, Sealth Programs;Models: Program Descriptions; Questionnaires; SpecialPrograms; Training

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ABSTRACT'Graduate educatiorgof administrators for Dental

retardation anedevelopsental disability prOgrams are defined .underthe umbrella of HealtiServides Administration. These Programs havein common'the delivery of health care. Prom the administrativestandpoint, the broad area of human services.mustbe brought down tomanageable, functional segments, but must also be concerned with allof the human services. A way an administrator can relate to other.Allman services is by first having a thorough knowledge andunderstanding of the health care delivery system and the role* apagement plays within it. This initial working document deals withgriduate education for administrators of mental retardation,development disability programs, and institutions. Included is aquestionnaire and risults that identify major functional areas ofresponsibilities for administrators. (Author/ME)

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******************************8****************************************.* Documents acquired by 'ERIC include many informal unpublished . *

* materials Apt availabletfrom other sources. ERIC sakes every effort *.* to obtain the best copy available. Nevertheless, items of marginal ** reproducibility are Often encountered and this affects the quality ** of the microfiche and hardcopy reproductions ERIC makes available *

* Via the ERIC Document Reproduction Service (URS). IDES is not *

* responsible for the quality of the original dodusent. Meptoductions ** supplied .by- IDES are the best that can be.sade from the original. * .

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a

posmolv PAPERRezifed Edition

EDUCAtION OF HEA.LTH SERVICE ADMINIST

IN AN INTERDISCIkINARY.

RATORS

MODEL

by

Jerry 0. Elder

Ch

Wilbu Clayouse

Melva

J. Roberrnt Grarles

V. Reeran, Jr.D.'Peters

Adrian E.

" i1 S OfPANTAAESITOf HEALTH

EoucArres.WELFARE

NATIONALINSTITUTE

Of

EDUCATION

THIS DOCuMENTNAS "-SEEN

REPRO.

OuGEOEXACTLY

AS RECEIVEDFROM

THEPERSON OR

ORGANIZATIONORIGIN-

ATING ITPOINTS Of

VIEW OR OPINIONS

STATED DONOT NECESSARILY

*ERRE

SENT Of f iciAL NATIONALINSTITUTE

of

EDUCATIONPOSITION

OR POLICY

a investigation wee s4pported by ProjecrEo. ACT-9616112

6om.the Division of Wealth Services ?robing

. The Bureau of Community Health Serlees :

'health Se 14es Administration- -------------

Department bf H tb Education & Welfare,,.A

4.

)

Published by

University of Oregon Health Sciences Center

Portland, Oregon

January, 1976 Y4111

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a

PREFACE

//

Health Services Administration is a broad field covering many

specialties relating to the management of various types of health care

delivery programs and institutions. These specialty fields range from

the traditional institutional hoSpital administrator to the various ad-

ministration spectalties'emerging in the fields of mental retardation,

community mental health and other health care systems.' It is argued

by some that the administrator of

be concerned with the whole range

care delivery.. These individuals

in the developing program

services administration,model.

a health care delivery systeni should,

of human services and not just health

, therefore, feel that administrators

lr--areas should be trained under a human

In this position paper, however, the subject matt is limited 'to

graduate education of administrators for mental retardation and develop-

mental disability programs whit are defined, herein under the umbrella

of Health Services Adininistration. Thefeprograms have in common the

- delivery' of health care to the AmOtUan public.' The administrator must

recognize that functions, activities and programs have to be divided

into manageable units. From an administratiVe standpoint the broad area

of human services must be brought daWn to'manafeable functional segments.

At the, same time, however, the administrator must be concerned with all

of the human services.

ministrator can relate

thOrough knowledge and

The authors feel thatpne of the best ways an ad-.

, .

to other human services is by first having a

understanding of the health care delivery system

iii

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r,

andthe role manageMent plays within it. The scope of this position

paper is confined to the education of administrators under the health

services administration model.

This position paper is intended to serve as an initial working

document on the subjeCt matter of graduate education for administrators

of mental retardation/developmental disability programs and institutions.

It can and shoilid.serve as a focus for discussion and debate by educators,

administrators, and executives of agencies and organizations. From these

discussions specific actions can be,taken to further develop educational

programs in this field. The advancement of such educational programs is

the overwhelming objective behind the publication of this .

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TABLE OF CONTENTS

PREFACE

a,

iii

INTRODUCTION 1

Historical Review 1

Administrator's Training Project 3

PROJECT RATIONALE 13

POSITION 17

REVIEW OF ISSUES 19

Education of Students '19

A ComparisoeBetween Mental Health andMental Re,tardation Administration, 22

Various Options of Degree Awarding Programs 41

Basic Curricutum Development 42

.QUESTIONNAIRE RESULTS , 45

Introduction 45

Demographic Data 46

Responsibilities for Administrators 50

RECOMMENDATIONS AND CONCLUSIONS 53.

Introduction 53

Section One 53

Recommendation #1 53



Section Two 57


Recommendation #2_7 ./ 58

Recommendation #3 -59


Recommendation #5a

62

SUMMARY 65

'16PPENDIX A 67

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V

.INTRODUCTION

HISWORIC1tL4.REV/EW

,.health services administration is i$OidIy changing: There is a

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decided change in t he libeling and training of hospital administrators.

II'Previously training focused on "bricks 4 d mortar" internal operations,

with little phasis on events outside institutional halls. Now the

trend is to a broader training so that an administAtor can go into an

institutional or program setting. Par t of this change is evident .in the

name change of hospital administration courses to health administration.

There are many specialty areas under the broad umbrella-of Health

C

Services Administration. Such a list might include, but would not be

'1Wmited to, 1) hospital administration, 2) nursing home administration,

3) clinid managemeht, 4) mental health administration, 5) mental retar-*

dation administration, 6) developmental disability administration,

71:agnostic and treatment center administration, 8) health planning;

9) health regulatory agency administration, 10) public health admini-

station. Some of these areas are primarily institutional, others

,primarily programmal and others are a_combination of both. .,ThWposition

- spaper addresses itself primarily to twb of these areas; mental retardation

.administration and developmentardisability administration. Included

under these two areas are institutions for the retarded, deinstitution-

alization prograris, community D.D. programs, state and region -D.D. ,0)

program coordinators, numerous developmental disability -;iagnostic and

treatment programs, group care homeS and usiFeraity affiliated facilities.;

4

.

Although the Federal definition of developmental disability_ includes

mental retardation, in this position paper both terms are utilized since

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there is still coniiierable debate and conflict con ruing the def-'

inition of developmental disabilities. It should also be recognized

that many developmental didability programs do not receivefederal

funding, and thus are ,got bound by this definition. They serve many

populations or sub-populations not included in the federal definitions.

The federal definition of developmental disabilities is contained in

Public Law 94-143, the `!Developtntally MieSbledAssistance 6 Bill of

Rights Act," which 1ncludes only the seiiere.and profound cases. of MR.

This eliminates all social and cultural retardation and mild mental

retardation." The definition also includes-epilepsy, cerebral palsy,

autism and dyslexia. 'Aecently efforts have- been made to add learning

disorde

Most organizations working with developmental disability dollars

. are actually working with "very modest kinds of funding. Title'I,' Part

C of, the Developmental Disabilities Act, which has to do'with coordina-

tion, -of state funding within the states, haslIbiOught about some influence

that id impressive when the amgunt of the money spent is considered. The

other part of the Developmental bisabiliiies Act, however, is the service

delivery system which tnvolves the University Affiliated Facilities.

Some people argue that developmental disabilities is, in fact,,a service

delivery system, but there is very.little evidence of such a system. If

one looks at the direction.tievelopmenta disabilities is going it needs

to be considered in relation to the service systems.'

-Although a number of groups and knowledgeable individuals within the

field of mental retardation' and develdpmental disabilities.have all ex-

pressed the.need for better education of, administrators there has been

.

t

little -agreement on how this need should be met/ The administrators group

of the University Affiliated Facilities (UAFs) is one element concerned

with educating these administrators. For -the last two years, authors Of, .

this position paper, as administrators of UAYs have been working to find'6

ways of meeting this need. It is anticipated-that the recommendations

listed in this position paper can establish a diction for Loire train-,/

ing of entry level administratOrs into the specialty areas of mental re-'

tardation and developmental disabilities.

ADMINISTRATOR'S TRAINING PROJECT

The effort which culminated into this position paper was begun in

1

May of 1973. A group of concerned UAF administrators first met in Denver,

Colorado to develop a core curriculum of administrative subjects that

all disciplines within.University Affiliated Facilities should be taught.

At'this meeting the need was also expressed for upgrading the skills of

11` existing,UAF administrators. The possibility of funditg a management

improveient workshop from the Bureau of Community, Health Services, Heald:

Services Administration, DHEW was discussed and the administrators were

successful in obtaining funding for such a workshop. The University of

Oregon Health Sciences Center acted.as the fiscal agent. The planning

committee consisted of:

Jerry O. Elder', Project Director, Administrator, Child Development

and Rehabilitation Center, University of Oregon

. Health Sciences Center,

R. Wilburn Clouse, Asst. Dir. for Admin., J.F..Kennedy Center for

IResearch on Education and Human DeSelopment,

George Peabody College,

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Ron Thorkilson, Administrator, UAF Exceptional thild Center, Utah

State University,

Ed Onorati, Associate Director for Administration, Mailman Center

for Child Development, University of Miami.

'This committee was established to set up and coordinate the workshop.

Maximum participation from all UAF administrators was solicited regarding

topics for discussion at the workshop. The Workshop was held in New Or-

leans in November, 1973 in cooperation with and the help of the Graduate/

.

Program in Health Services Administration, Tulane University-School of

Public Health and Tropical Medicine. 1 At this workshop, which was the.

first opportunity for the 45 UAF administrators present to meet separately

and discuss mutual, problems, it was evident there was a need to better

educate existing administrators and also those coming intet field.

,A small group of adMinistrators expressed their willingness volunteer"'

to serve on a committee to do work on this problem.

Impetus for the next step came in April, 1974 when the Bureau of

II

Community Health Services funded a grant application to extend the effort

that,w10 st ted with the work;hop. The administrators who had-voliiii,,-.--

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'teered to serve on the planning committee first met is7May 'a 1974 at1

the AA:1D annual meeting in Toronto: This planning committeconsisted.of:

Jerry O. Elder, Project Director

R. Wilburn Clouse, Associate Project Director

J. Robert Gray, Administrator, Division of DisOrders of Development. /

-and Learning, University _ofHorth Carolina

1 irOCeedingsof_this workshop were published. Single copies cat be

obtained from the Child Development and:Riehabilitation Center,University of OregOn Health Sciences Ceater.

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Vic Keeran (CharlL V. Keeran, Jr.), Associate Dir ctor, Administrationo

The Neuropsychiatric Institute,, Mental Retardation Program,

.UCLA'

MelVi ters, Administrator, Child'Deveiopment Center, University,

) of Tennessee

Adrian E. Williamson, Administrator, John F. Kennedy Child Develop-

ment Center, University of Colrado Medical Center,

(Another member, Mr. Thomas A. Knok7-whu Resi-

dent at the John F. Kennedy Institute for Rehabilitation of the Mentally.

and Physically Handicapped Child in Baltimore, Maryland, originally s ed

on the committee. Mr. Knox took a position with a Prdfessionai4tandaids

Review organization in August, 1974 and, therefore, lef e committee at

-7

that time).

The objectives of this project' were fo -fold:

1) To assess tke educational and experience competency of existing

UAF administrators.

2) To maximize the involvement'of existing UAF adminiStrators in

the development this project.

3) To develop a curriculum for training new UAF administrators which

--------would,1ead .to' a master's degree. in Health Administration.

/

4) To d elop appropriate mechanisms for upgrading the mansgeiial

kills of existi4A1AF administrators.

After the project had begun, it became aivarent there were a number

of'problems connected with these objectives. The illarlying pne was that

the pr'oject's scope VAS too lu;.trow -it dealt only with UAF administrators:

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The -prof ct's direc on was expanded to include admitratoiCs of mental

retardatin and dev opmental disability institutiona, programs and

similar mu idiscip ined type programs., Becuase of the emphasi on

training in UAFs and because they are excellent interdiscipli ry train-

ing,laboratOries, it was felt that UAF administrators have a res

bility,for developing administrative education in the MR/DD fields.

The first two objectives were accomplished through the development

of-;a questionnaire Which is described elsewhere in this position paper.

The third, objective was premature in that after the authors initiated .,

the project and learned of other effOrts in the field, it became obvious.4%

that they were presumptuous tobelieve that they could develop a set

'currictilum that would be accepted by graduate programs in hialth care

administration or any funding agency. This objective was modified,and

now reads: "to examine the current status of graduate program education

for administra rs of mental retardation, developmental disability and

similar multidis6iplined type programs to determine bow the need for

educating entryleel administrative position's cars/,best be met". The

fourth objective was\ expanded t& include DD and MR administrators

and is being accomplished in conjurIction with the Task Force.on Mentalr

. .

Health and mental Retardation AdministratiOn..:A separate/report will

be published in the spring of 1976 concerning the continuing.

education aspects/of both mental health and Mental retardation acimini-

strator ed c ions/

Efforis for the training project began in/April, 1974/When the

/.-. .

//

project director, Jerry Elder, attended a s siori at :t e annual meeting, ... /

.s

of the siaciation of University Programs/in Health/hdriinistratiop:..

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of

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-entitled "Models of Mental Health Administration ": This was the first

timeffehat ALMA held a separate session on mental health administration

education. Information on four programs in various stages of deirelopment .

or operation was preiented at this meeting. A 9ajoi concern expressed 4

at the session was that nb research had been done on whether there is any

difference between a mental health ora.mental retardation administrato

111

, and general health administrators. A question was raised as to what is

administration

stration? The

in mental health and is it unique to general health admini-

-

group could tot agree on what is included in administration.

The first meeting of the UAF administrator's project planning coMmit-

.tee was hbld Toronto at the AAMD meeting. At that meeting a general .

plan was laid out on how the prOject should be approached. It was decided

4

that Mr. Elder should travel to Washington, D.C. to meet and discuss with

various OdividUalsawho have an interest in the area of.training admini-

strators

.

strators for developmental disability programs.. In August,1974 Mr: Elder

met and talked with the following individuals: '0

_ .

Don McNamee, Administrator, Eunice Kennedy Shriver Center,. Boston,

Mass, r. McN been working with Mr. Keeran.atthe.

request of the UAF tteeilothe'Hational Advisory Council

on )Developmental Disibilities be'develop a trainingproposal

.4y

based upon a model of,RUman Services Administration. However,.

to date no proposal has been submitted.

Patricia Cahill, Loni-Term Care Director; Association' of University

/Programs in Health Administration, Washington! D.C. It, wee felta

that the project should coordinate its effOrti with this profes-.

-sioaal organization since they repreisent4e mejorgraduate

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programs in health administration throughout the country. Pat

Cahilt is also the staff person whocoordlnates the activities

of the Task Force on Mental Health andtimental Retardation

Administration.

William Wilsnack, President's Committee on Mental ketardation,'Wash.

.

D.C. In the past the PCHR had Worked onand had submitted a

pr9posal for an. administrative training program. It was sub-

mitted to'the secretary of HEW but the procedures which they hadN

proposed were not accepted and it was never approved.

George Bouthilet, Ph.D., UPF Representative, Developmental Dtsabili-

11 ties Division, SRS, Washington, D.C. Dr. Bouthilet weevery

interested in our project. *He was 'helpful in, pointing out other

,individtals and agencies who have expressed an interesiii,

treining,eaministrators in developmental disabiliti,progieeii.

'Jean DeBell,',DirectOr, Research Management Improvement Programs.

National Science Foundation, Washington, D.C., NSF isvconcerned

with, and 'hes funded a number of mariagement training prOjects.1

One of the idiijor areas is the buildinfi"of'-ianagement oompenten7'JP

\' cies.This 4felt to'e a, potential sognyce of funding fog atty

treining,prOgraessthet might be developed.

Dr. Saul 'peldean, piilector'td\the Staff Cbllege, National Institute.%

, ,

oe,MeiltalHealth, :.Because Elder'. conVeAations with" ,'../e a N

'Dr./NaldfuOini Pat 1, khe,wataby)(bes invited to the. ,

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First ,National 'Eonfenenne on Education for,ti entail Hee/tli,,Admink-''

. V, \ 'N,! ' . ,.

',,stratian which,'was held incNre °Aeons in early Nerch, 1974;,,

..

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This coordination Wlih the.mental health administrator educe- *.

tion.efforts has been both valuable and fruitful:

V

4110James Papal, Chief, University Programs SeCtion, Division of Health

' Setvices,'Bureau of Coliimunity Health Services. These discusiions''A

. _

centered around.poSsibli funding of any training proposal that

might be developed..

Robert_ McNeill, Executive4pirector, American Association a University

Affiliated g (KAUAP). Bob McNeill has'also served As a

focal nt for coordina ng the project's efforts with other

S,ag cies And keeping them info d of our activities and ce

ve His office was used as a Working headquarters during Mr.

Elder Visit in Washington, D.C.

The next st was the development of the questionnaire. Mr. Elder.

and R. Wilburn ClOus , Associate Project Director, met in August, to

develop the initial aft for this..

questionnaire. The questionnaire was

sent to the other co ttee members for their comments and was reviewed by

other UAF administr

New York.

tors at the annual meeting of the.AADAP in Valhalla,

Since Mr. El r and Mr. Reeran woluld be attending the'first National

Conference on Edu tion for Mental Health Adisinistrators, it was decided

to postpone a curriculum development meeting with consultants from gradu-

ate programs in health administration until after that conference, This

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was fortunate, since we realized,.as a result of that conference, that the

committee was premature to try andodevelop a curriculum that could be

'accepted bjgraduate program in health care administration throughout

.attr

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111

the country. Because of the similaritybetween problems of mental health

administrators and mental retardation/developmental disability admini-.

'strators, it was decided to change the focus of the curriculum develop-

sent

.

meat meeting toione of examining the current itatus of graduate education

programs and how it could best meet the need of training administrators

without prior experiente for entry level positions, into the field of

-mental,retardation and developmental disability administration. Mother

reason for not developing a set curricului at this meeting_urs-thai -4e

were moving along much faster than the Task! Pierce on Mental Health and

Mental Retardation Administration. It was felt that we should retrench

and try to fit into their'time schedule since the peculiarities of adhini-

stration in these two, specialty areas' are verytsimilar.

_The authors, along with lames Papai, Chief, University Programs

' Section, Division of Health Services-Training, Bureau of Community Health

- Services met in Denver, Colorado March 24'and 25, 1975 with represents-,

tives -from the following prOgrams:

Gordon D. Brown, Ph.D., professor in Charge, Graduate Program

'in Community Systems Planning fi Development, Pennsylvania State

University.

Walter H. Burnett, Ph.D., Director, Graduate Program in Health'

Services and Hospital Administration, Tulane University Medical

Center.

Patricia A. Cahill, Director, Office of Long-Term Care, Assomir

ation of Univers ity Programs in gealth Administration.

John F. rralewski, Ph.D.. DireCtoriProgram in Health Administration,

Department"offfteventive Medicine and Comprehensive Hdelth Care,

University of-Coloredo. 16-10-. .

John R. Malban, Project Director, Men Administration

Training, Program in Hospital and Health Care Adminitr ion,

University of Minnesota.

These individualil represented various styles of grad' to programs

7 from schools with different philosophies. It was an exc lent group and1

'everybody during the two-day meeting was very oongenia and'helpful. The

consultants all complimented each other on their con tions to the

meeting and lively interchanges of opinions/and p am philosophies were

exchanged. This kind.of interchange was extremely oductive; to be able

to sit down and rap in a small group for two days th administrators on

one side and educators on the other side.

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PROJECT RATIONALE

There has been much rhetoric concerning the need for'bettei training

of admiXistrators in the developmental disability and mental retardation

fields. The N tional Advisory Council on Developmental Disabilities and

the President's Committee on Mental Retardation are just two of the major

bodies which at one time or another have expressed the need for developing

administrative training dapabiliti+ in these areas. The documentation of

this need,,however, has not been established and the exact number and

type of administrators needed has not been demonstrated. IThe questionnaire

that was undertaken as part of the administrator's training project did

address itself-to health services administration manpower and qtatus needs.

The results of the questionnaire, presented in detail in appendix A, show

that in those progrpms.which responded to the questionnaire the following

new administrative positions are planned in the next two to five years.

Degree Level No. of New" Positions

Baccalaureate 152

Masters 167

Doctorate 67

No real conclusions_ can be drawn from this except that from the 170 ques-

tionnaires that were returped, 234 post bachelor positions will be created 7

in the next two to five -Years. This givesaome indication of the need

there will be for trained developmental disability and mental retardation

administrators in the coming years. Althomfbmthe questionnaires were not

coded to determine whether these 170 responses cane from separate institur

tions and programsg-it is known that there wpm some,overlap. t it safe

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181.

"VW

to estimate, however, that at least 100 different programs or institutions

are represented from these 170 responses. It iF easy to, see from this

small sample if there is-a need for 234 post bashelor administrative

positions from 100 different programs iNit the -mope would be if projected

nationwide.A

The need to place well- educated Administrators in these new positions

should be fairly obvious. However in the past many persons have been

placed in these positions with inadequate administrative training and, in

some cases, little desire tote an administrator. The authors of this

position paper feel that an administrator should be both committed to the

values of the field into which he is going and have the necessary educe-.

tional background to fill any administrative position.

The University Affiliated Facilities can prods excellent labora-.

tories for practicum working experience, the kind-that is essential for

administrative interns or residents in the manta] or deve-

lopmental disability fields. Each UAF is similarAn some ways and

different in othefs. Each has operations that ararespond4ng to certain

4sorts of conflicts and pcessuresthat determine it, One Of these has

.

to do with the fact that UAFs are obviousli interdisciplinary project

oriented. This creates conflicts within academic institutions -since

it is always coming counter to the departmental base structure. This has

some definite training'advantages, however, SinCO realities of a community

basedirogram are project'orienied and not departmental_ oriented. There-

fore, the itudent can gain insight into this orientation in the UM

Another unique aspect of the UAFs that make their an ideal !basis for

the practicum experience is the carrying out of the organisational mission.

19

.

Because of the complexities of the type of handicapping conditions seen

in a UAF, the only way thiscan be accomplished is through team finding,

team staffing and team management. This goes back into the history of

rehabilitation institutions, state mental health hospitals, state schools,

etc. -Jihe,UAFs are now institutionalizing this as a training model.

,

UAFs can provide the student in a graduate program id health care admini-

stration an excellent example of-the type of realities he will be dealing

with after' he finishes the practicum experience.

If advocates of each of the specialized fields under Health services

administration were gathered together, each would undoubtedly argue that

their ownfield is un4fue or different from the, others. Is'this uniqueness

significant enough to Justify separate educational- programs to train

administrators in each of these fields? The differences in administration

of the various specialty fields is an area of regearch that needs to be

investigated. Because there is no concrete empirical data to indicate

whether mental retardation' and deirelopment disability administration is

or is not unique, the authors can only go on their own feelings, attitudes

andexperiences.

There are some distinctive characteristics-in the MR/DD field that

modify the nature2of the administrator's function. Becadse of these

differencei and because of the changes that a e occurring in graduate. .

programs for health adminisqation, the authors felt the need to_develop

a position paper rather than a simple repdtt. -We hope that this position

paper cancan both point out some of these distinctive,characteristics and

show how they differ Cr Agree with'other specialty areas. We also hope

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to'influence the direction of graduate program cation for administra=

tors of specialty. programs er health nistration.

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POSITION

As a result of the investigationt undertaken by the authors the

-lollowing positions have been determined:

(l The fields of mental retardation/developmental disabilities,

and mental health have-characteristics that make them distinc-

tive enough to justify unique training formats for their admin-

-'

istrators.

(2) Existing giaduate education programs in health administrmtiorri

are a logical place to most closely meet the needs of

educating administrators itr the specialty field omental

retardation/developmental disabilities. HbweNer; these program's

have historically been opera onalized around single discipline

indtitutional models and are rt equipped to deal with the

multidisciplined environment of NH/DD administration. These

graduate pro are currently not meeting the needs of4

ry

A educating MR/DD a trators.

(3)Th'rough joinefforts between individual graduate programs and

UAFs and through the organizational efforts of the Association

of University Programs in Health AdministretiOn:and the American,

AssOciation#' University Affiliated Programs, graduate eduda;-/

tion programs-can be modifiect.to.meet the needs of educating

MRIDD v.administrators.t

,

,

----

(4) There are enough4imilarities between 03tn4stratipin the

fields of mental retardation/developmental disabilities and...,

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mental health .o advocate close cooperatiOn'and coordination in

deVeloping educational programs for them.

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EDUCATION OF STUDENTS

REVIEW OF ISSUES

The demand fof well:-trained t iniaX,rs- in mental-retardation and

Lde4f1100antal-disability,programs and Institutions has created a, dilemma.

demand at the current time iS lor argeneralist or thetop administra-

to However, there are not enoughadequately'trained people with the

proper experience to fill these positions. It is,rather foolish to be-

lieve,that a student without prior experience in the field, coming'out of

. a graduate program-in health'administration, Caniassumethis top spot in

all bia a'few of the small community' organizations. Individuals co

out of,graduate programs should Instead be moving intvsecond , third

echelonpOsitions to gain the necessary experience in Order io,later assume

the top management position in. an organization-.

On the other hand, clinical staff who have n been adequately

trained in administrative skills are currently/assuming top.management

positions,.- (This probliM4ill be spoken-to,In a separate report on

continuing education.),

°.

There was sentiment expressed:at the Denver meeting against labeling

the type of person we are talking, about as a developmental disability or

mental tetardation,administrator. It was felt that this was too rests c-

tive. Instead,-it was felt this personshould4e called a health bervice'

administrator. Here, a number of opti are available Apendini upon

r

' the particular kinds of heel& adkinistration the'ftudent if interest

-

in or fees hiatelf,finctiohing in. __The Developmfntal Disability Act

,-"

specifies certain corMitions ta,its definition of DD. This,definition

. . ,

-19-

_

is unnecessarily restrictive in terms of administration of DD programs.,

There are a-number of programs fn the health services field-that have

similar requirements in terms,of/knowledge, skill and function, and same

of 'these are-.hOt in the area of mental retardation, developmental dim.--,

i,..,

y or handicappipg care.

The field of hospital administration is gradually changing its

philosophy from hospital to health administration. It allows within

that option forthe student-to socialite into some area outside the

hospital. In the field of health services administration there are,4

ofinecessity specialized areas. However,' there is a common body of

knowledge that everyone within is-area needs to know or at least be

aware of, =uch as basic organizational issues, financing,_ management

n pts andotherAxead that are mentioned under the broad curriculum

outlined in the questionnaire results.

4/-h64itk administrator is now a different type of_health admini-,

strator because hospitals are no longer existing,in the isolation they

, once did. If today's hoipital administrator does not know howto relate

//to community agenCies,.to governmental agencies, etc., he is not doing'

his job. He is specialized; however, in that he is different from then.

individual who runs a community based health services clinic. of any kind.

.

These are different focuses stemming from the iame'general body of admini-

,strative knowledge.

It was argued at the Denver meeting. that f6r the sake of semantics,

%.(,

,,

much.administrktive education ill common to most, if not all,,ireas of, %

administration. This has to do with certain kinds of geheric decisions *-

,,.

which are basic to management. It doesn't%matter whether you are managing. -//

,

. k\,-.

a movie theater or a state mental hospital, or whether you are worrying

about elective surgery admissions. 'One has to unieiStand the contekt

management and there are some things that go across tthe board when one

is dealing with health. The manager has to be able to pull these kinds

of things out; know some of them and how to deal` with, them when he is

confronted with them five years from now. However, one can't build a

rq

Capacity,for dealing with.conteqls easily as one can build a valpacity

for dealing with*certain generic kinds of decisions, and it appea

that building that capacity'is a mat4r Of sophistication that.

with experience.

A good mani4er will gain in'time, the mSturity and experience to

assume a top management-position. However, a studeht 6.194 out of a

graduate prograii d es not normally start there.' When it gOmes=400,the'

,

4), r

nitty-gritties of managing an organization, probably 80 percent of it is

in cpmmon generic term's, but the other 20 per cent that is unique must

be learned in the fielki in which a person is working.

A question was raised during the Denver meetings. When one considers

anorganizationblitis"putting together a large number .of disciplines

ieducation,,social aspaCts, rehabilitation, etc.); who is the executive

director of this organization and what is his discipline?.

Is it a-. ,

health discipline atell? It was concluded that this person could come

J,4 . rf( 4 14-

:fro *erioesidisciplines.but theprerequisite`is,thathe must have broad

S'e

..)

adm iitAtiue skills. However, it was' felt that for entry level posi-

.6

tions,,sinte.:the most common element within these organisations is health,', -

, .

-t ,

.

.. ,,--

that 'he could well make out of the health'serVices administration graduate1

,program, The student, however, must tik made asareof the totality of ,

..

.. ,.

-21-

26

.16

Ar

human needs. As an example, if you' are an architect, you should not

design a building that just looks beautiful', you must,realize that

people will live in it and they' have to get to the bathroom and some

are 'in wheelchairs ana some are seven feet tall. Having eregerd for layman

interest and what he is.designing doesn't mean that,the architect runs

the educational programs of the health program; or ing elie. He

just needs an awareness of human needs, at least human ac lities.

Also, those concerned with social welfare must realize the impact of

=economic factors, ,health factors, education factors; etc.' Somewhere

0in between the two'definitions.of human services a_dministration and

o 40(bealt4 services administration there is another concept which was coined

In Denver; interdiscAinary program administration. This is where thd

University, Affiliated -Facilities can serve as an excelleft training

,mcdel for students in health services administration.

There was argument dying £he Deincer meeting for adopting the'human

-S e tots proo tai. rffi "ms philosophy.. "emit cleal

.with it, it was necessary ,to limit the 4rettion to health services admitii-').

stration: The concern was with the in the top s'ot, the overall

apinistrato of mn organization, and that ab7.0 to co4 with thote

things he.isliZa

Others felt that we

restrict our curriculum 4i

programs. Soma felt a 'Mono

thinking too provincially if Viewer. to /

sions to a health services administratio

stration curriculum would work just/.

well. In essence:they ying that the pedigree that the individ

out WO is not ab utely crucial to .the you14..beNh

r

..-

..l'.^...41Mmter'S in public trealth.or business administration or a major in

. .27

a

s41.-

V4

.

IP

, .

administrat' -health care administration. The important, thing is thatit.

, .

.

the individual ves graduate degree `in administration and ,a currieultie

rvlevant to the mental retardation and developmental disability field. As,:,

long as the basic administrative curriculua is there aoademically, the

entry into mental retardation or DD can be provided at the practicum level.

The University'Affiliated Facilities can provide that componeht.1

An interesting item that came- out of the first National Conference on

Education for Mental Health Administration in Neworleanspilmr9V5-7t was

that six out of the twelve small grou 'in which discussions took place,. .

indicated that too much tiNeilienymade of the point that mental health 4,-';

administration is a specialty. In fact, there las more generic subject

matter in mental health administration that met the eye. The consensus

was that the Task Force on Mental Health and Manta' Retardation Admini-'

stration should look at generic:subject matter, not'to re-invent the

: .

t.

, whadIde 4.77r".

---e"

A COMPARISON BETWEEN MENTAL HEALTH AND MENTAL ikermanom

.

msbtslly were often served

by the same system. Parents of retarded children, 40wever, started ques-

tioning whether or not their interests were being adequately met via the

mental health model. In some states there were separate programs for the

retarded. This decision was reinforced by organisational changes at the

federal level. Nevertheless,, when considering the administrative regiiire-

ments, somb assume no differentiation is required in the preparation of

Patricia A. Cahill: "Pirit NaiionalfiConference on Iducation for.MentalNealthridministration", unpublished final import; June, 1975:

administrators. Others hold that mental retardation and other develop-

mental disabilities are so different as to necessitate specialised

curriculum educational experience. Therefore, at the Denver meeting this

topic was explored in some-detail and a transcript of portions of these

Iv

A 4

discussions follow;.

Vit Keeran indicated that he has moved back and forth between both

the mental health and mental retardation irYitems. In his current oppecity*

as Associate Director, Administration, HP2, UCLA, he lentos as the admini-.nor

strator of programs in mental retardation, child psychiatry, adhlt psychi-

;atryN and neurology. Vic initiated the diecussiabing describing some of

his observations. (His remarks have been edited to improve the written

pommunication.)

Mr. Xeeran:

""My --cement" avi diriected towards ferances the tee, systami'

-;11ohiCh"lielt- be appreciated in planning the IducatiOn otadministrators.,

I will not beconcerned With how thews differences -shoula be ack:XiW-.

ledged in-the educational process:,that-can be.aaaressed later.

Instme my remarks the intendeCtdrinitiate this portiont

of a dis-.

cussion to determine whether or mot therm is a general agreement on

the nature :of these differences.

Let me start by identifying my own bias. I believe that there are,.

differences, but they are differences of-degree not kipd. As I 'see

it, ireas of uniqueness between the two systems can be treoed,tocfour

basic factors: (1) Chronicity or the length of time 100 individual

will regairs services, (2) The probable ago of entry into the system,;

29, ti

(3) Consumer involvement and,, (4) The-prop;iiInn nf multi-system

involvement. My'comments will focus on each of these factors.

A. Chronicity of Length of Time in the System,

When individuals enter the mental health,system the assuMption is

generally made that they will be treated, move through the system)

and back into society with no further need. for service: However, it

.

., .

is recognized that a certain number of the, mentally -ill wtllequire

long term care and rehabilitation.. Interestingly enough. those who

-Will require long term care cannot.te identified by $01rtOls dr char-'

acteristics. They are gradually identified*by .4errpragmetic:

,process -- the fAct they continue to need servioes.from.theflyetem;

By contrast individuals who enter the mental retardation/develomentai

.-.01"iisability systems aze ordinarilwyiewedes people wfwprixlgAquirer.,.

services for a long period of time. The primary variable is not -

service versus no service, but type'of service, intensity; and length

of the interval. From the beginning, plans are made to accomiodate

the needs of this individual and"the family for a Significant- time,:

- - --

if not foie his/her entire life.N

However, it is fbund that.a

proportion will improve rapidly and no longer need the system. These

individuals are usually identified pZiogramatically, i.e. through the",

termination of their need for services from the system.

B. Age of Entry Into the System

,.

. .

Most individuals enter the MR/DD systole as children. By definition

the conditions which disuse mental retardation are present at birth

725-

3011.

"

-.`1.7- -

or are manifested during the developmental period. There.is a well

known clustering of diagnoses by age -- conditions that are evident

from birth_tottle4end,of the first year; those that become evident

in pre-school years and those that are identified in connection with

the educational systems. One rarely hears of an adult entering

the system for the first time. This factor produces a number of*

aftendant modifiCations in the characteristics of the system. Clearly

- entry programs-Must be geared to all of the problems of children --

childhood illhesses,ImMunizatiobs, education and healthy growth and

development. In addition the SystemMust Accommodate to the inter-.

action with the parents of the client, and with all of the associated .

-pe4cholOgical, social and legal implications.

--"Proili.iis-are-litely--tobe'geared.toigke_nsedsitof.childreneOr:enotter ,

NI 4 WI1 /144."1...k.. 4V4.7.

reason -- our societal hias-es expressed:by caretakers at all leve/s.

: -

--Sineer tardation,with'srrestekor delayed

development, there .is aninOlinetion to :relate to" the' retarded as

children regeidless-of their chronological age.

-, -There are, of. courset.programs for OenteIly-ill chidren. Aeide-fram,

,.,._course q_

: , -

the-.Cute-chronic issue discussed earlier,: there is a went-commonality_ .

in the characteristics of the rho systems: -/be lirgest differences

are noted in

referable to

developient,

care,

the adult programs. The*e differences are primarily

the,age of entry into the system, pre-care levels of

pre-care socio-ecohomic roles, and probable' duration of

4 31

0

C. The Role of the Contumer

We are all aware of the growing voice of the consumer. However, I

believe that the pasents of the mentally retarded and other develop-

mentally dilAbled constitute one of the strongest, best organized,

influential groups of consumers of any of the human services. They

play:I.mportant'roles in legislation, political and court action,

and serve as strong advocates. Systems that serve the mentally

retarded and developmentally disabled must be organized and admini-

stored In light Of this high level of.organizational sophistication

and provide accountability to parents as consumers.

There are growin4 activities among consumer groups and legal advo-.00 ,

of rightscUthe mentally ill, butithey,are unlikeky-th.reach ti

the level of importance of the MR/DD consumer groups.

D. Multi-System InvOlvement

I have characterized those who enter the MR/DD systems as children'

who will require a variety of services over_s significant portion of

their life span.* These services may include substitutes for-family-.

living, specialized educational facilities, specialized recreational

resources, vocational and employment'services, psychiatric services

or any oethe-health care services for acute or long term disorders.

abet administrator-might manage a direct service agency, or be respon-

,Bible -for-planning, coordinating or integrating elements of a broader

network of services. Therefore, it is' likely that those working, in

MR/bb agencies will at least have to link with a greater-variety of

, 0

-27-

1 (1 ,

agencies and are more likely to need strong operating ties to

agencies that operate under the sponsorship Of another type of system.

The administrator ofMR/DD facilitiei may also find more varied

streams of public funding requiring accommodation to a broader

variety of funding agencies.

In summary, I believe these are matters of degree rathet than'differ-

ences in kind. Furthermore, I believe that rather than the mental

health-mental retardation paradigm, a better distinction is drawn

when analyzed by a fourfold matrix consisting of problems of adult

aid children who need acute or long-term care (exhibit 1).' In any

event, it seems that a great deal of further discussion is required

hefdt L,5

,

elIigent conclusions can be teachadaboUt the iMpliqations

for education of administrators."

EXHIBIT 1

A Comparison ,of Health Care Delivery Systems

I

Variables: Mental Retardation Mental Health I, Medical Caie

AcuteVIP& ,

Chronic Care,

Age Groups: Primarily

Children

I

I

ia4-1 y I

Plait'I

Dr. Brown:

"I would almost include another box in your illustration which would,.

%-be the traditional medical care model and r think it would even serve

to accentuate'the differences."

Dr. Burnett:

"I think it's even more than that,- If we had a little different

audience here and we went through the same exercise, what you would

do is have the acute hospital where you've got mental health and

exactly .the same arguments would be made in the Contrast.. The link-

ages, the total services, the age, the nature of the staff, etc.

The other thing that I don't see ih your scheme is e very heavy

.s %, ,

dependence of bo esesectors on public funding onN tax baie."

Mr. Keeran:

"That's very important. I think MR is even more pendent then mental

health on public funding. YoU'go to.the American spital Association

Psychiatric ServicenSeCtion and you increasfpgly get exposed to the'

guys in private sector. MR is buying a lot more of the acute services

than it usedsto. This. area is starting to theconcept of

case management and purchase of services is gett g a lot more

people to the-private chunk of this than there used tobe.3-5 years

ago."

Mr. Papai:

That depends on who's doing the buying. If you still talktra

about public money, which is buying from what youlcall the private

sector, I don't really consider that private sec r.' Its just,

,.-another name for a public.,

-29-

44

IL*

Mr. Keeran:

"I would disagree with you, Jim, from,the point-01-view-ofthe adminis-

trator. If I'm sitting out there in ABC intermediate care ,facility

and it worked back to the private-enterprise iYetem,,you may be

buying froa-me as the director of.a regional center, but you don't

have the same problems I have around cash flow, around the

Mr. Papai:

"The basic statement-was in terms of publicly funded and I think one

has to bear that in mind

Dr. Burnett:

"But let -'-s- -explore this a little further. First of all we,sterted., .

with a basic statement. Essentially the hl!lth industry is a public--344% -

service industry in that the great bUlk of it-comes from public----

monies without a doubt, as our fkiend the economists have shown us

time and time again. The question which then is raieed when you're

talking about organizational behaviOr is the for that that f 4

takes. That tundinq can take place on a contra ual 43asis where you

can negotiate-the-grolind-rules, _for example Title VIII reimbursement,

although I guess not too many people'thinic that is very negotiable.

Or it can be a budgetary process where you have a series-of line

items that could turn into contracts from the Federal Government or

appropriations from State Government. The organizational behavior

is very different in ihOse two ki-M4iof'settings.,iihat we.iee, 'I

would argue particularly in the_disabilitiesareai im-a. very heavy

dependence upon the budget. Tgle amount of money is appropriated, toy

do X, Y and Z, Whereas if you'move into some other area, you get into

-30-

5

the negotiations of acontract as part of a-broader income producing

Strategy. Ix seems to me that's ab'solutely crucial in understanding

hOw these work."

k.

Mr. Keeran:

"It would apprear to me that there are many more similarities between

long-term care and mental retardation issues than acute and mental

health issues."

"I'm not so sure this isn't the point I was trying to.show you between

ta.,.,

institutT"ival vs.,non-instiOtpnalkinds of-concerese

,

"A. lot of it has to do with what they assume 46iit the-environne

which is the thing we spend a lot of time looking at. In other'.

words, in the modell0 mental. retardation, really focus a great

4deal at the environment', how you make the educational environment

adaptable to this individual, the specific characteristics, him you__-

make the job environment. In fact, underthe Department ofLabor

now they have requirements for matching-funds to programs which

employ certain numbers of DD people, if they, get fedez'l funds.. SO

you4are really trying to adjust the environment as opposed to. adjust-

ing the individual to fit back into-i traditional environment. It'sQ

-. .

a

been the acute care or medical model though, I would that is

changing in this direction because there is more chradic illness and

long-term care."

Mr. Keeran:

"Once the philosophy shifts to health care as a right rather thatilor

.

.4.

those whO can afford to purchase care, it seems-to bring a lot of

this together."

Dr. Brown:

w.

"1,agree; in fact, in the two areas you still have on the board you're

saying does the DD have an educational problem or is that.a health

problem? It's pretty damn difficult."

Mr16,Mtilban: _.. . . ,.....--1,-71,

"Why do you have to make that distinction..,

Dr. Brown:

"I'm saying you can't." -1,

;Mr. 7? fban:

4

"But youave to."

Di. Brown:

"You use the health services model by default. That's whit I dis7

agree with."

Mr. Elder:

"Because of why?"

Mr. Papal:

N

"Because as administrators we must recognize that things 40tve to be,Not

in manageable units and I don't see any quarrel whatsoever between

looking at a child with.whatever kind of DD and saying that he has

many needs, among which are education,,social services and health,

etc.- But the realities are that no one perion can knOw enough about

all those fields to do everything. No one agency, private or public

hat responsibility for all those fields and even like HEW, which

comes the closest for obvioua reasons. it.has got to have specializedyT

732

.r

yF

agencies and within that, specialized people Who understand theP.

nature of the problem they are dealing with. So,'from an administra-

tive standpoint. you'vf got to break it donor' to manageable functional

areas. 'I speak to the health services area because that is what I

represent.\ I don't think thetmeihs at all that we don't recognize4 0

0y,, aol 0.,

or support the'ieceittity in tip '941EdAlitatiOn!,

compqnents, social" components, whatever they May t,. there

is en inter-relationship,T770t7nOW414 it* Aut ; or any.otharlpne.- .

.

person can, know enough about all'those things to do it all."

s.

Mr. Gray:

'1119 ohe person has to know it. The UAI

Mr. Papai

"Then, this is all I'm talking about. Within this complex, we're

talking about people who know those Ainds of concerns within health

services administration.

Mr. Gray:

"The UAF incorporates all those reeources."

Mr. Bapai

"Precisely, which is why I think it is the mast marvelous training

resource we have going."

Mr. Gray:

"But it's not limited tohealth se4ices."

Mr. Elder:

FBut it is on a relatively small scale."0

, Mr. Papal:

."It is on a relatively small scale. Within that though, if ypu're

training a health services adMinistrator; which is what I hope we're

. ,

44

,14talking about, he is being trained in a situation_ where he'ii exposed

td' and

the

mus work with the other kinds of programs-that have impact on

I servicesthat'ohild needs, which is why it's a beautiful'

aining resource, but'you are pot` aining the persorrjn the health

serktices-fielk.tei become an cational administrator. There are other

people with other co' rns that know better the demands' of the purely

educatiorial k s of processes. You' 4triningwa,per,son thouglithat "-

knows e gh about the'educati eds to wo:rk with the people-in

tion."

Mis- Cahill:

"I .heard G

deliv

,

an de-Scribe it beadtifully, I though whbn heti

for us last year and he said it's lb case of

ng atrthe whole human being and while you may be primarily

responsible fo;* the delivery of a given'set og-servicesi_you are;irell

aware of the_variety of needs that affect an individual and how yoU

cart facilitate for him getting those services or getting money to-

ovide him those services. You know the whole bag, but you're not

immediately responsible/far it.

Dr. Brown:

"I'd lke to resp4nd to that in tWIS respects. Just-some observations.

'aim I dent agree with them or disagree with them. The example you

101 give, first of,all, Has been describing what has been and I'm note

$

Burp that's.going to -be a reflection of what shoUld,have beelit or what is..,.,

going to be. 1 thin& there are new bodelsof community services -.

..

ocial services in communities ate evolving and one Should be cognizant.._,.

S-

..of those. In add+tion, in, terms of setting up an acadernic model,/

I think,that i3ne accepts this argument, one specializes in one,

area,40Wthere certainly is a very rich mix of concerns. This would

lreport even further the ,human services model where people are trained

together and we don't hi've to go through what we did in hospital admi-

nistration and planning where -we had separate graduate programs and

4

tney are literally trained toloe thediatenealmid tralldtoha:417. 4r00194.4*......4- ' .P. '73 ._ .,. . Nim : .. ...r... . i .,-:--'.4r-ir... , irr., FIK7, 4; r-7,. wow:. , ,.. 7,r, , 1 ,. - , ..,

. .-4 . o i

, .

true. For example,, in our program we have people on'mental health 411....

, .

traineeships who learn health, justice and welfare. What'You say is(-

'true - they do haveA different bias, a different,professiondi orien--

* ,

tation and thii-get int some violentLarguments. Within the academic

"model,'this is just a he4th prOblvm-____They say, well -hell, it isn't

eitherlobk at

-

all the money we have in justice, this is really

justice probleit."A

Mr. Papai:

"What you are really saying is.that these things inter-relate and

,t

that's the concept Dr. Tarjan expressed lieu eloquently and which

am trying to

Dr. Bro

"Ali I'm- saying is that I think we ought to question vary seriously

the a parating,out oft academic models into separate isolated 1

acad-

Mi. Papai:_

r I'm not.suggesting that academic models be separated out; What

I'm saying i.e if we know how to do something, we've got to have

1,..;

some specialization, because nobody can Conquer the Universe. I

,.

think on a relatively lower scale, the doncept.thit you were jUit

empressing about pelvis arguing over "it's this one," or "itii tAis

/.

concern or that", is what's happening within ban. We h e many

different disciplines concerned with heSkth, education d rein-

bilitation, etc., and the Ohole point of training them- ogether

in that one center is sb they develop an appreciation f-the

totality of What's tiended. We do not,hoever, tr4 to train' A

social worker to be a.nurse or to be 'a paycholOgist, ut she's%

,trained with-thohe people so she understands their p feasional- 4

input. She still comes out a social worker *Rd the psychologist.

comes ohta psychologist, but you're hopefully giv

better understanding of total needs:"

g them some,o-

These disCuseions are a good examole of the excel ant\tintributio411\

that was madi-by all those in attendance at thee Denver meeting. \In

.summary'it would apprear there are-two.najor differen,ea betreenmestal

health and-mehtal retardation-administration. ,In ne al retardatfs9h,7

_ there .is a necessity to .consider and sometimes, manage 1;rger variety.. . ,

og setvigla* than just health-sal:id illnesa4 This leans dialing with other,-,. - 1,-, A ,-1.

.. v . ...,.. . \

agencies and other diiciplines (such as epetial educaxion, vocational-. .

, rehabilitatiOn, social welfare) andthe'funds involved with i6a. /be

other difference isa greater involvement of_cOnsumers ,itthe seital7e-.

.\..,tardatioh field. . .

/ .

/'However, there are many more similarities beta's- Health ' ...

\ ,, 4

, administration and mental retardation administration than there are . \ -,

.

-,. . . . ... .diffetenCes. There are number of progtamCin the-health seriices area'

A\

,-.

.

i.that have similar requirements in to of knoglidge,skill-and fund on.. , . 7. .

4 6

At the recent National Conference on Educsti for Mental Hellth'Admia-.".

' .. . . .,-

ti

istritidn, host oLtI:'administrators. in at

vn

-36

412

OD We .ihmmagemof,.

4

mentalhealth institutions tad organizations.' A number ofindividuals

kwere also administrators of mental retardation and developmental disability

programs. There was no debate whatsoever between differences of these

two types of programs as far as adMinistration is concerned It was

61111 ,

discovered at that confiience that although an administrator for a

"I

community nental.health center and an administrabr Walarge state,

system were looking at administration from two different. vantage points

and NIHH was looking at ft from an 'overview of the field, the, kinds of.

probleasthey related (in terms of administration fqr program and_faci-

lities) were very repetitive. For,eximple,-they all,discusSed bureau-,

()rata tangles similar to the bUreaucratil tangles of universities.

They also mentioned finances and combining a variety of'financial

'source. and the problems or dealing with avarietyof-professionsla:-

Consumerism was also a big problem along with evaluation and accounta-

_

bility.: However, by the end of the first day the participants heeled

their fill Of a discussiori,of administrative function. They wanted to

get at more specific isaues on education for the field.. They .

wanted to get into curziculum development.. 'How doges a person get the

4

knowledge and skill and at whit level in the"educational.:continuul would

this be given? These were the kinds of questioni that participants at1

that National Conference were asking. On the final afternoon a panel

.

began to get at this huestion but this was at the end of thelorogram

and:they were oily able to begin discussing these'questions".. This fs

'-

currently the same situation in which the authors, as adminigtratore of

0

UAFs, find ourselves:

;

-37- .

,

ti

.

. ,Thkpaperswhithere presented at' that coiferencerpointed °et-many

types' of Problems witichseaTilliadminietretors, ensile:mt. These

are also the same ones experienced by administrators of mental retardation

and DD facilities and Programs. Although there arevery distinct and

different program concepts between mental: halthand mental retardation,-. -

the problems that adninistratorsexperience in managing these organisations

pre almost identical. To illustrate this point, excerpts from a paper

presented at that conference by Dr. SaulFeldisen, DirediOr of the Staff-, E

College at.VINWare included here.3 In his-paper, Dr.- Feldman presSnted

eight didtinctive chaiecteristics that substantially modify the nature

Ofa.mentalhealth adninistmltor's task. if, as'you read through then,

you ,simply substitute mental retardation or,DD-in the place of the words,substitute

.. w .

-. mental health-foteach.o( thesecharecteristics,. yon,-Vill also have a

diitription of the -distinetiva cheracteristica 4041Ministrative problems. . , -

...

,..,..,.

...

I

in the held of MR/DD edministrittqn: *-

beseedninistratiOn alai 1 filth- iffersfrom adminIStraWinimAeorSare47-Simitir:Sreas because the Mental.4.- Z.:

" -!' -heolth-tield. has distpsetcieratteristiesthet.aulittentially modify

the nature of_ the lidmisittrative-tesk.a-,Theek includei

Firkr,.rentel health services are dependent upon public funding and

Ire. frequentlysubject.to a high degree of go ernmen regulation4

tisit*, ;

-Adhinistratore of these sei*ices-must

pqlitital prociis and be able C ork.

levels. Wb4le the degree invol

afore underStand the

afly with goenrzseSiii it all.

arias between political

juriedictiOns,,beth.624constraints and opportunities inherent in^

. 4.-

'.

. -3' Saul Feldhan, "AdminIstiation in'Nent4Bealth: Issues,

,and Prospects, pnpublished:RiperL Hatch, 1975.

4\3-,-35--

,

11$

C

ti

t11.--,lr....r=ge'

close ties to government are omnipresent in mental health administration.

Second, the typical staff in a mental health organisation is multi-

disciplinary, professional and'highly autonomous '- a bit like a navy

with more admirals than ships. Disciplinary rivalries, conflicts

.around status and salary differences and a professionalism that is

inversely related to organizational loyalty add to the complexity

of the mental health administrator's task. In a study of 120CMHCs*

for example,, Jones, et al concluded that thepstaff members in the

centers viewed agency policy as expendable to professional standards.

Third, the transaction between the therapist and patient is highly

private and intimate n mental health -- must more so than in most

other fields. .As a result, it is very diffidult for the organize-,

tion to collaborate frith or intrude into the process, even when

warranted. It is not unusual for the patient and therapist to

enter into an alliance, not always conscious, in which'the organi-,

zation is viewed as the enemy, particularly regarding such unplea-.

santries as fee charging and decisions to terminate treatment.

Fourth, in mental health, we are frequently dealing with a highly

dependent patient population and this presents extraordinary prob.-

lems for the administrator and the stitff it}. maintaining a responsive,

.

accolintable.and humane program. The reCurrent public scandals in

some of our State mental hospitals and institutions for thegetarded

4are unhappy reminders of these problems.

44-39-_

4

Fifth, our product is highly intangible-and our criteria of success

are very difficulto determine and to measure. The terrain is

littered with ill-conceived and executed evaluation studies and the

technology of evaluation in mental health remains quite limited.

It is, therefore, very difficult for the mental. health administrator

to evaluate the effectiveness of the organization, or evenef

individual stiff Members for that matter. These difficulties also'

exist for outside groups and organizations attempting to evaluate

, the utility of mental

that at least some of5

Ahealth agencies. As a result, I suspect

these agencies survive, and even grow, long

after they haVcstopped being of value Up anyone-.

Sixth,-the boundaries of AentalNhealth services are very difficult. ,.

to define as exemplified by the noir too familiar and tiresome debate

in community Mental health between advocates of the "medical..r model

and those of the "social' model. While this ambivalence about

boundaries and objectives has some obvious advantages,'perticUlarleyJO

for the administrator who wishes to avoid_accountability,it permits

the mental health Organization to be seen- as, the vehicle for meeting

a wide variety of frequently,divergent needs and encourages unreal.

expectations. It is those expectations that have accounted for

some of the well publicized conflictsin our community mental health

, programs.V.

Seventh, the public image bf mental health services, the.enduring

stigmkthat is associated' with their use end.thiproblems of

I

4

p,

confidentiality add a.significant complicating" to the adtini-..

-strative task,in the mental health field.

And last, somewhat less tangible but perhaps most important, is the

need for'a mental health organization to communicate hope and.confi-

dence to the people using its services: As Whittington has written,

7

"While a surgeon may perform an operation with high technical

,competence even though he feels that the leader of his program is

'autocratic, arbitrary and derogates his importance, the mental

health practitioner can rarely function with optimal efficiency

if he has similar feelings about the leader. In every transaction

with a patient, the management of a mental health center is an

invisible, but by no means silent' partner',"

It seems rather obvious that these characteristics that make adti-

nistrative tasks in mental health administration distinctive are also

4Ptrue of the fields of mental retardation and DD administration.

VARtcps OPTIONS OF DEGREE AWARDING PROGRAMS-

There mai some discussion at the Denver meeting given to the possi-

bility Of an external degree. This, however, deals primarily with,theI ,

currant administrator who needs to upgrade his skills while still

continuing his present managerial position. Since thisfits more in. . . .

the line of continUing education, thii point will spoken to in the

.. ... . i

report on continuing education. ,...,

4 ..

. b, .

.

.There were four different graduate progress reccesentedire the

.,Denver emoting. All were housed in' different areas' of universities

1

-417

4

-It

and all had somewhat a different philosophical base. It was felt that

this was not'ted at all because-if all were doing exactly the same

thing with the same- structure, there would be very little creativity

and program,advancement. All pinograms; however, have the capability to

teach the basic generic administration and managerial, skills.

Data from the questionnaire results can be used in terms of deciding

what'content should go into the formil academic programs. Therefore,

t, can be added to this section is to reiterate that there', ,

area number of avenues for a student desiring to go into health servicele--

administration to pursue the basic generic.educationalsrepaation.

Different approaches should be tried and experimented with.

BASIC CURRICULUM DEVELOPMENT

There was some very liyely and interesting discussion concerning

curriculum development at the Denver committee meeting. The essence of

acme of that discussion follows, since it gives an'insight into how the

authors arrived atsome of their recommendations.

An important concept brought out waa that one of the real funda-

mental issues'of our thinking was that Management is the only field

where axerson is educated to go into a.role that he is not going to

fill-as. soon as he gets out of school." If you &Qs educitmo yourself,

`to become a social worker, you know what *your4firsi job is going to be

like. On the other.hend, those in m4agehent are theoretically trained

to be a top executive, but in realiVwiWmorelikely enter into a.,

second or third level management position. this potion hii to 'be.-

experienced in the perticuler-field'in Which he is'Working biome he is

-42-

t 1

ca

theoretically capable of assuming a top management position. The impor-,

tance of haling a good solid background in such thipi,aa financial,

management and budgeting was stressed. This kind of course work in school

and the realities of arsd management in an actual

position somewhat disimilar. Most of the vractical issues have to

be on the job and cannot be leaned -in- an setting.

One of the areas that is distinctive to this field and

included in a curriculum for-a DD or an MR graduate is th importance

of moving these programs into the communities. 'Community centers have

evolved along two different lines. One is very close to the community

health model where they find themselves as providers of services at

the community level. The other is where the community center is essen-

tially a purchaser of services br'a case manager. If a person were being

trained to-go into oneof the case management type prOgrams to administer

a regional center, there is a lot in the health administrator background

that would'be beneficial, to him. However, unless he is also acquainted

with some of the broader components relative to ot11% systems, it,will

be very difficUlt.for hlim to administer such-a program. Consideration

has to be giveh to including aspects of these-Other programs in a curri-

cuium,,,such-an administrator has to'be able to ppll together all these

different types of functions and know how to dea). with them. llowever,

it is questionable whether you can build that capacity for,dealinq with' .

i q. , . .

then in the context of an academic setting. You can build in the calm-.. .. _ , V',

_ -City by _dealing kith certain generic kinds of-management decieiens, but

.

it would appear that the capacity to deal with other areas has to,come-,,

)

yith the eophistication,,that-comes with eXperienCe.A

. _

-- 426-;

There was some dialogue in the Denver meeting, but very few concrete

results about the characteristics a student should have after hr

finiehes at least one year in a gtaudate health care administration'

prOgram. .

-*

V.

4

Mb.

,r t

QUESTIONNAIRE RESULTS

INTRODUCTION

The evolution of decision making theory in-the past decade has

taken a definite trend toward the quantitative, operations-redearch

and management science approaches, with a secondary orientation to

organizational decision behavior. The effects of these trends have

raised a number of interesting question lated to the operations and

Management of multi-discipline health-related organizations as well as

questions related to the education of health service adminiktrators.

Theserfroblems have long been of interest to UAF and other health-

related administrators. The need to review current health service

related training programs and to suggest possible curriculum adjust-

ments was discussed01in 'some detail at the OAF Management Improvement

workshop in New Orleans in November of 19/3.

In order to help identify themajor functional areas of responsi-

bilities for administrators, six different groups related to health.-

services aaministration were requestedto complete and return the

questionnaire developed by the UAF administrator's training project

,planning Ccumittee.4 The questionnaire requested demographic data from

each; participant and his organization as gel/ as his educated opinion

about competencies in,10 major management areas with 59 subrareas. The

Auestionneire was mailed to the following six groups: (11.Director=

a .

4' A copy of the questionnaire and a complete tabulation of the results

Are presented, in Appendix A.

A

UAF and MR centers, (2) Administrators - UAF and MR centers, (3)'COord4,-

nators r state programs of MR, (4)- Governmental staff,' (5) Graduate

school health program directors and (6) Community developmental disi-

bilities directors. These groups represented a wide range of persons.

interested in health services administration who are at' different

organizational levels and who' have different functions. The question-1;

naire was-mailed to.31 6 individuals and'170 questionnaires were returned

completed for a,54 percent return rate.

'Each person responding to the questionnaire was r equested to provide#

,,,sonte limited personal and organizational data. The personal data re-

quested included information on educationalbadkground, administrative

experience and age. The organizational data requested included infov!

mation on organizational base, size of organizatiOn, operating budget

and manpower status.

Perdial Data

From the personal data collected and shown in chart form in Appendix.

A, pages78-79, under Academic Background, AdministrativatlAmprience and

Age, one can make the following generalizations aboUt the groups who

ctinpleted the questionnaire:

Academic Background5

S.

88% ,of the directors hold the doctoral.degmlms (44%. MD, 33i PhDs.'

11%,EdD: and 11%'hold the masters d eel. ,

Some 'totals do.not equal 100% because of some missed data.

f

't'

.3

F..

,-46-'

f

q.

4

a

- 60% of the administrators hold theetastfrs,degsse;11% hold

the doctoral degree and 27% hold the bacholorIdegree.

- 31% of the coordinators of state MR programs.had the doctoral

degree, 584 hold the masters degree.44nd%13% hold the bachelor-

'degree.

69% of the governmental siaff.holdithe masters degree, and

19% hold the doctoral degree:

-.79% of the graduate school program faculty had the doctoral

degree and 13% hold the masters degree:

- 60% of the Community developeental.,disabilities directors, .

told the masters. degree; 27% hold the doctoral degree and

11% hold the bachelor degree.

Administrative Experience

The questionnaire, results.indicatedothtt a 'high percent of all

groups had mote than 5 years of administrative experience: T14 data

revealed that 93% of all director's had more than 5 years administrative

experience as did 7,7% of the administrators, 80% of the'Coordinators

state program direCtorsof MR, 94%.of the governmental staff, 83% of

the graduate school program directors and 64% of. the community dove-

,11.

lopmental disabilities directors.

-4Age

.j

The ,age for all Aix: groups' ranged-froes.26 to 64 with the *enrage

y

g per group 44 fOlicAs directors administrators ;62. 4

coordinators - state programs of MR. - 41, governmental-staff - 50,

-47-

, .4

,-,. . .

r

graddate school program directors

4

disabilities directors 39.

PrOm these personal dita we

- 41, andCommunity developmental'

psis able, to obtain inlbrmation from

a representative group of individuals sowho ars interdited and concernid,.

mbout health services administration. These data wire extremely*

-

valuable in analyzing the, responses to the Mubstantive sdttion of the

questionnaire...4".

-Organizational Characteristics

From the organizationaldata collected ands1; in chart formin

Appendix A,- (under Organizational Base, Staff'MeMbers; Clients Served

elr

Per Year, Operating Budget and Administrative MaApoWer). One can magb

the following generalizations about the orginizationrepresentma in

the survey.

Organizational Base VI

4,

Of,

The questionnaire results indicated that 71% of the UNFAnd MR

research centers are located at, public univergities along with 65%.

of the graduate programs in health administration. As expected,, the, .

. , ...

a, 1

I

organizational base fox. state, programs in MR, and cdimunity devel.Omenr

tal disabilities programs are primarily based at,the state-level.;

Staff Sizeo

. -The.survey so indicated thdtisorwthan 40,000.6dividuals are

-- currently saplo ed-in the various institutions; ,Of Chips number, ;

t .

11,942 are cl asified as4r?feaeignal,and 28,15411W6mlaPqrtOg ter*

providei a,proipasionalcUieupport ratio;orla.37.sohnel. Th

'0

A.';11' 0

'N4

Clients, Served

4 The clients si4ed per year by the institutionse.surVeyed range from

less than 100 .itI'more than,5,000. The data indicated that 40 % to 50%of. 4 4

the institutions,serve from 500 to 1,500 clients per year.'. .

eOperating Budget

The operating budgets for the instiititions surveyed ranged frOm

lessthin$2510,000 per fear' to more than $5,000,000 per'year. Approxi-'

,

mately 50% of these institutions halie,an operating budget between/

$500,000 And $3,000,000 per year.

Administrative Manpower

'The suiVey also indicated,that there are S694, administrative

//positions in the

the number, 619

current structure of the ,institutions surveyed. Of-0

are,at the doctoral level, .1,248-ere at the masters

/ lave' and 3,827 are at the bachelors level. These institutions are

also, protecting MR increase in the number of new admintitratIve..,

a/i

- .

positions/in the next three years. "They fare protecting 386 new

administrativd positions, 67'Wi11 be at the 'doctoral 167 at the

;masters degree level. ancf 152 aithe bachelors degree level.,

Tie thiearganisational data it appWilt. that we' were able to obtainI" f'

/information from:a wide variety of organizations' concealed with health

.care administration, Theoretically, this Should help make the substantive

sections,Mf our position ,paper mOra valid andlielpful-in.planning for

curriculum.change.

a G

41.

RESPONSI$ILITIES FOR ADMINISTRATORS

The six different groups previously described were requested to

.reSPond to 59 major functional areas of management systems on a Likert

Scale of 1 to 5. Each person was requested., to indicate the degree of

involvement for administrators in each of the 59 areas. From this data,

it can be inferred what role and to what degree an administrator should ti

be involved with the major functional arias of managehebt forhealth

services related programs.

Analysis of variance Jith multiple groups was:run on each of the

59'items for each group. From these analyses, group means were calcu-:

e

fated along.with'the P-valUe. (The complete analysis of ,variance for11,

each' iiem.is shOwn in Appendii A, pages'84-89. P-values below the

0.05 level indicate significant group mean differences.) Ofttof thei . .-

594itemiCanalyzed,-only'14 had a P-value dtless than 0.05. This

indicates a high degiee of similarity in the group responses.

it is diffieuti te pilliPoint'abY-majOrttends,a few,general'obsFvation#-

canfbe made from these data. Inlieneral-it cants said that dikebtprs,

administrators

, i

patterns tb the.

.. ..

,

schdol directors cc Inity developmental disabilities directors

tend to Closter together. Administrators,tend.to rank items slightly

and governMental staff tend to respond. in Similar.4 .

59 items, anCcoordiOatori.of state Programs, graduate'

higher thin did other groups. Coordinators of state MR programs and

community develepmental disabilities directors tend to rank the need

far supporting-Spite-mil lower than other groups. This, may 'Indicate their

reliapce upon eklating supporting Systems located in the -state goiernment

of coMmunity levels.

-50- r.

P

re&

, -

In order to simplify data presentation, the 59 areas were grouped-.

iRto 10 major management areas and group means were calculated oreach

area along with the rank prder by groups. These data ere.shown in

Exhibit 2, page 52.

The group mean for all,groups shown in Exhibit 2 ranged.from a

low of '2.95 to a high of 4.411 an the Likert Scale. .These. relatively-..,,,z

.

,

hi`gli scores indicatee a strong preference for,each of the major manage-

:1

.

vent areas listed in Exhibit 2. The rank order for eat major manage -rr

/.

. .

tent area shows that each group places emphasis on different managerial

x i. 1.1"

--...I I

.i4

'funvtions, but that the relatively high mean scores indicate a strong.

-prefeFincefor all 10 managementrareas. t

.'..'

,.

,+ are a number of interesting analyses and conclus ions that't

.can be drawn from'the results of,this questionnaire. The authors feel,

however; that this position p r is, not the appropriate pit& for these. #

A ,

detailed analyset tebe Made. The ques are results, howeve'r, can

and should be Used.by UAFs to recommend (to graduate in health

administration) ithe areas that should be included in a basic curriculum

4for educating ;MR and DD administrators. The areas of responsibilities

listed in the-questionnaire results, along with the list of topical

areas in the recommendations and conclusions section, can be used as a

r

planning document for developing future 'program curricula..

'

56-51-

.

al

P. Principles of Organization

and Management

Organizational Development

'Personnel Systems

Direction end Communication

Controlling-Operations

'Financial Development

and Accounting

I

Economics and Cost Analysis

Exiernal Organizational

'elationship

Management Information

'..System

Health Care Delivery

System

4

:)tmllail. 2

GROUP. MEANS AND RANK ORDER

Dirgctors

AdMin.

,

Coors t)

State Prog.

Gov't.

Staff

Grad. Prog.

Directors

Commuo.

D.. D. Pirs.

/lean

Rank

Mean

Rank

Mean.

Rank

Me;an,

Rank

Mean

'Rank

Mean

Rank

4:08

34..39

54.34

1.

4,4

14.43

14.41

1

1.88

74.32

7

-

3.70

64.00

43.83

53.85

6

3.91

64.35

63.39

8

i

3.74 ,

1

3.21

10

3:59

9

3.80

94,01

93.94

33.75

6

r-

3.98

4.04

3

'3.94

54.48

1,3.50

73.78

53.69

-6

3.76

7'

4.15

14.45

22.95

10

3.46

10

-

3.42

83.49

10

3.82

-8 ,.

4.30

8,"

3.23

93.66

93.30

9.

3.70

. 8

3.70

10

, 4.05-

10

3.85

53.69

t

83.68

:7

3.88

5

4

.

24.4f.'

43.97

"2

4.31

2

.

4.06

'2

4.21

2

4.0

44.44

33.93

44.02

33.99

3'1.03

4

/,

tr

-

RECOMMENDATIONS AND CONCLUSIONS(1.

INTRODUCTION

This position paper has thus-far reviewed 4 number of issues and

considerations that speak to the graduate education, of administrators

for Mental Retardation and Developmental Disability programs and facil-,

ities. Ale recommendations, with supporting information based upon

these issues are divided into two sections. The first section consists.

of three recommendations that necessitate actions by agencies and in-

diViduals externai to UAFs in order to implement them. They are more

global and long-range in nature than the other recosmiensdailonS. Imple-

mentation of the five, recommendations in the second section is dependent

upon cooperative arrangements between'UAF administrators and DirectOrs

of Graduate Programs.in Health Administration.- They do not requirt

yoordination or support from other agencies in order to initiate them.

SECTION ONE

-RECOMMENDATION #1

That a manpower study be undertaken to ascertain the

number and type of educated administrators that will be4

needed in the fields of mental retardation and-developmental

disabilities for the next 5;104'15 and 20 years.

There have been'numerous estimates of the number of trained admin-

4

istrators that will beneeded in the fields of menta4, retardation and

developmental disabilities in the coming years. It would be a vela-

tively simple task far the authors to present their own recommendations

based upon the resu/ts 'of our- questionnaire. However, all of these

would be rough estimates based upon very little factual information-.

It is essential that those designing graduate programs for administra-.

tors in these specialty. fields have at their disposal an accurate body

pf information concerning the need for administrators in the coming

'years.

RECOMMENDATION #2

`ft

That lines of communication and working relationships be

developed between the Association of University Programs in

Health Administration and the American Association of Univer-

\,sity Affiliated Programs to facilitate working relationships

between individual graduate programs in health administration

and.UAFs.

The Association of University PrograMi in Health Administration

(AUPHA) is a professional organiiatidh that grew out of the need on the

part of graduale programs in hospital administration 25 or 30 years ago

to band together to share common problems. Esbentially the program is

based on curriculUm development for University programs. Its primary

activities are intask forces. These spin out.into some research,pro-

jects, a couple of which are now going on are appropriate to this

field. There are.some other activities of AUPHA thlt fall into thezi

area of logistiesupport. It is an organization that is going through

a major growth period and'changing its orieniation:-.Although in the '

past the 'organization was ptimarily institution 'oriented,' itsip-4tangiqg

-54-

41

to meet the needs of new-interests and focus. The Task Force on Mental

Health apd Mental,Ritardation Administration.is one example of this new

effort.

There are currently 38 graduate programs that belong to the AUPHA.

All of these programs are full members of the association. There are

:three other categories of membership: 1) associate, either in transi-

tion to full membership or undergraduate programs, 2) associate

members for foreign purposes and 3) individual memberships.

The accreditation of these graduate programs was formerly carried

out by the AUPHA, but is now carried out by a separate commission, The

Accrediting Commission on Graduate Education fOr Health Administration.

This commission is composed of representatives from the AURA, American

Public Health Alsociation, American Hospital Asiociation and American`

College of Hospital Administrators. The commission membership is

currently being expanded. In the future'someone will represent planning

interests through the American Association of Comprehensive Health

Planners, the Nursing Home Administrator College, ambulatory care repre-

sented by the clinic manager's group and mental health administration

through the Association of'- Mental Health Administrators.

Since the AUPHA is fast changing to meet the needs of an expanding

l

health administration field, close working relationships with it are

essential.

RECOMMENDATION #1

That multiple sources of funding be investigated and

promoted by the AAUAP and individual administrators to finance

the development of graduate program education for administra-

tors of MR/DD facilities and programs.

The questionf;-'4a-'TUndfng for this whole-area is a crucial one.

The minimal een g far io'develOithis position

paper and the.management improvement

sity Prog

shop lias come from the Univer-

ivisiOn of Health Services Training, Bureau of

Community Health Service eaZth Services Administration. They do not

have the capability to support fu time faculty unless that was one of

the top priorities of a particular UAF The do have the capability of

supporting stipends for train ips in administration in a particular

UAF. support 4st fit in with the overall priorities of

the individual UAF and would usually involve shifting-the use of exist-

ing funds. Tbs amount of money that they would have available for this

purpose is very limited. I -

The other major potential source-of funding would be through, cthe

Developmental Disabilities i Office in eOffice of Human Development.

The Deveippmental,Disabilities at one time taineda'provision

for funds for tra of administrators. However, this was dropped

the legislation.

The President's Committee on Mental Retardation, although:not a

funding agency, can serve as a supporting organization to legislate

financial support for adMinistrative training programs.

1

-56-

SECTION TWO

That

on Mental

RECOMMENDATION 11-

this position paper be, presented to the ,Tar Force.4

Health and Mental Retardation Administratidn for their

.consideration and that administrators of TJAFs work together with

'the Task Force to develop a curriculum which will be applicable

to both mental health administration and mental retardation/

developmental disabilities administration.

Because of the similarities in administration of mental health and

MR/DD irograts and institutionsit is desirable to haVe the efforts.of

thetAF'administrator's training project dovetail With those of the

Task Force on' Mental Health and Mental Retardation AdMinistration.

The results of the questionnaire, found in Appendix A contain some

Of the basic curriculum areas that should be includedina generic

. N. .

administration graduate program. The authors, of course, realize that

the.exact-curriculum format will differ depending upon_tha'particular

graduate program in which the, student is enrolled. At the Denver meet-

% S'

ing a laindry lief of subject area was developect-thit'we feel should be

included in-a graduate program curriculum.. 'These were as,follows:

Problem SolVitig

- Planning -

,prganization'tructureRelationship

. Financial ManegOents; Budget conceptualizatiOn

,FormulationJustification

Cost Analysis and Forecasti4g

Expenditure.MonitoriigFunding

Client Charictertstics,In;erventi* Modalities

-57-

02

Y

It

a

1

Service Systeh CharagteristicsMulti-functioning/Multi-disciplineUse of generic agenciesAdvocate/Legal righi6/ parents-consumers, ethical-issuesPublieereonnel SystehsPublic Education & Information +

This licst and the competencieS listed in the questionnaire results

can serve as input to the Task Force on Mental Health and Mental .

o

Retardation Administration. The Task Force should consider what

type of person a mental health, mental retardation or developmental

disability adginistrator should be. What type of areas,should.this Person be

skilled in? Whet type of attitudes should this person possess? With

such a descriptive pidture of what an administrator should be, it would

then be important to suggest a series of models of curriculum the Task

Force feels would produce this type of person.

There was some discussion At the Denver meeting as to whether all

of this exercise on curriculum development was necessary. it was felt

that all, parties need to be 'involved in this exercise and bhat it is

a necessary step. Five years from now we may discover that the best

way to handle this whole thing is-thf5Ugh-individualized practicum.

However, at this point curriculumdevelopment seems to be at 14.410 a

,necessary stage through which we must go.

RECOMMENDATION #2

That individuals who wish to go into entry level ladministrative

pos.tions in the, fields of mental retardation or developmental

63-se-

A

disability programs and institutions be directed to graduate

programs in health administration which have obeyeloped:adadeMic

affiliations with University Affiliated Facilities.

The main concern the authors have for a student going -into a graduaeb

program is that this person be able. to develOp the competencies to

become an effective administrator. The existing graduate programs in

health_ administration are more likely to haVe an existing structure

-which can provide this but we are not ruling out programs outside of

health administration. Most of the existing graduate programs in 0

health administration already have the basic generic curriculum in

administration which we feel- is important.

!

RECOMMENDATION #3

That university Affiliated Facility administrators develop

.working rblationships with individual graduate programs in health

administration to develop the practicum portion of a student's. .

education in administration.

The UAF,s can provide an excellent opportunity for,graduate

programs in health administrationrto link up with a training concept

that is multi-faceted apd will lOok at things from a multi-diMensiOnal

point of view. Ma student serves an administrative residency it a

UhF, he is not necessarily being trained to become a dAF administrator.

-"Instead, the authors are talking about a training focus Or situation

where aa, student can be involved in a lot of-activity 'that relates to the

6 4.-59-

0

. .

.

type,o1 functions he will be responsible for managing after his graduation.. . ,

°----

Because UhEd'are very much involved with agencies and Other,

activities ilg ttA community in terms--of-refefilds back and forth and in

terms of various kinds of continuing education of consultants, they are

In and of themselves marvelous training programs. Their, involvement with,-

the community and its agencies would offer the practicum student the

opportunity to spend pert of his practicum in some of the community

agencies that the UAFs are .

Since very few individuals are aware of this adminiattativetraining

potential in UAFse,' itis necessary for UAFs to make the approach to a

given graduate program in health administration for the purpose of

deVeloping 'a training relationship. With the information available

in-this position paper and the questionnaire results, it, is feasible

for UAF administrators and directors to facilitate a. formai interface

with graduate program faculty to bring that data together into some kind

of a matrix in rms of the kipd of information which administrators

ought to hav They can then sit down together and define tile .piacticumI A

an0 kinds .of experiences which UAFs can provide ana which the,adMini-,

strati'e student should face.

RECOMMENDATIO$ #4

, That UAFs play an active role inithe recruitment and selection

r---"---1of students -in the specialty areas of mental retardation ana deve

/

loppental disability-adminlistration.

It is very diffidurt to,de,iscribe the type of people who should be ,

4 I

t

Selected for-entry into these specialty' areas in hearth care edministra-r \

tion or any other,arees. What.Should,we look for in a student? 'What

experience,, if any, should he'have? WhatexpoSure to the field, intelli-

genceetc., is necessary. Thit is an area in Which much research needs

to be done.

0

Sincesin this position paper. we are talking about the student who

is going into7an entry level position, student selection'is a crucial

element. Although a laundry list of some sort'could be developed, the

essential point is that a rep;esentative of the UAFs in the person of

the administrator should haVe the capability of providing input to and

admisSlion screening committee. .

Another real problem is the appeal which the mental health and

mental retardation fields have tostudents comingzinto these areas. The

. ,

"nice shiny hosptal on the hill" has much more appeal to4 student coming

into this'type of program than our fields, which have a very low image

as far as the overall health care administration field is concerned.

Unless we have some type of involvement and can guide the student prior

to his entering 4raduattschopl or during the firif year Of his generic

administrative education, it-will be difficulrle get a commiitment

from the student to enter the field of mental retardation or develdp-.

mental disability administration.

One po s ilit'is.based upon a model of what is, being done to

recruit minority students. Between the, junior and senior_ year

undergraduate work, summerjobs can be constructer in which'people are

. brought in and put through an orientation as to what goes on in a UAF.

This could be orchestrated in a weekly seminar. 9

.

V.L

A

r ,

pne of the major elements to constaer'for admitting a student in

this area would beto(look'ht'stUdent; who have had some work eXPerience

in-this field or a related field and can demonstrate that-they have some

,potential and would be able to do the job once they are finiihed with

their edudatton..

.

Thelask Force on Mental Health and 'Mental. Retardation Adminihtra-..

. .

. .

tion recently addressed the question of what might be, looked for in a .

-. :

student`. They ;Recovered that he can come from a variety of background's

and has no p 'articular Personality characteristics except the potential

for,succets in their field of training.

RECOMMENDATION 1 415

That Odidminiatrators hold a faculty appointment in'the

graduate m in which, they develop an affiliation.

It is,essential that the administrator have a faculty appointment

'which follows the pattern of all other-training, in the UAFs. This way

''he or she can.represent the department which they happento be affiliated

with and can be influential-in changep of curriculum, -etc. If he does

hot sit on'the faculty council, it's'difficult to put: any change in the

curriculum and make it, relevant to the MR /DD field.

2

The practicality-of-combining'into one position the academic side'

program.of the ISAF and the operating end of it is very limited. It is

not always feasible'for the administrator who is,responsible for manage-. ,,

to "also have to undertake the' teaching workldad ipolved,

with-a formal faculty arpointment: The idea of hiring 'a faculty member

to carry the major lead of,thip,teaching responsibility is one alternative.

Although there is very little inconsistency between teaching and Managiugj

4

t

0

-,

'the time eleitient may make -it impractical., The other way of,approaching

this problem is to hire Sre'adminiatrafive.assistant to do post of the

routine work to Allow the administrator to do more in the teaching

area. The point-is that-the administrator may well have to make a chOice

a to whether 'his primary responsibility will be that of teaching or theA

day-to day manageient operations.'

Another real problem is that moft of the current UAF admiistratnis

have not obtained the highest academic degree available in their field.

. and, therefore, would not be considered for full faculty appointment to

a number of graduate programs. Although it is not necessary in some

schools for faculty to obtain the Highest.

degree available,An most this

is a real requirement. This is a point that Onuld have to be overcome'

0

by'individual negotiations between UAFs and graduate programs. The basic

principle, however, would be that'the adtinistrator faculty member's.'

. appointment should have prestige at least equal With any other faculty

,

member within that particular university'setting.

It would be desirous to develop a wide variety of working rela-,

tiOnships between UAFs and gradUate programs and to evaluate their effec-t.tiveness. Loose types of arrangements with no ,forinal faculty appoint-

,

-

ments in the graduate prograns 14ou1d be lesi influential wit the /./

Association of University Programs in Health Administrdtioi and their

constituents and also. less influential with other accredited .graduate

programs inhealth care administration.. 'A close working relatio

with forMal cademic appointments and the developmentofsp fled

kinds of programs where it isPossible to have on-lei relationships,.

1 ._ . . .

;.,',.4 '' 1

.

task forces,-and section mgetings'al ABM, ou more .effective.

aa

A

SUMMARY

overIl coordination with the Task Force on Mental Health and

Mental Retardation AdministratiA and AUPHA wiilbcertainly be helpful

in developing prograss,for educating administrators to go into the

MR/DD fields. 'However, the,only,way a program is going to be made tok-work is through organizational4irangementsbetween a particular UAF

and a particular graduate program. They will have to work out mechan-

isms for getting students into their program and for placing students0

When they graduate intg appropriate position.

In summary, there are four basic considerations in setting up

working relationships between UAFs and graduite progrfts in health

administration.

1. The practIc4m or administrative residency, whatever it is

-called, is. the mutual meeting, point.

.'.A series of activities in the area of student recruitmene

is essential.

3. Establishment of formal relationships b een AAUAP and

AUPHA.,e-

4. To use these formal relationships as well as faculty

appointments as a mechanism for avoiding somevf the

problems that have occurred before between operators and

educators.

7

-65-

69a

.

V

APPENDIX A

RESULTS'

HEALTH SERVICES ADMINISTRATOR EDUCATION

'>tr

. QUESTIONNAIRE

S

46

c -7

I

1r .*

,.-67 -

fir :h

4

HEALTH SERVICES ADMINISTRATOR EDUCATION'

QUESTIONNAIRE i-Tai-777

DEMOGRAPHIC DATA (Please check the following items that Ilitdescribes, your position and prganization.)

Or DataProcessing

Only

'7A. Posit ion (Please check only one.)

1-Program-Director

2- Administrative Directort,

3- Teaching Faculty ( )

4-Federal Governmental Program Staff ( )

5-State Governmental Program Staff (- )

46-Local Goverpmenta.1 ilitgram Staff' _( )

-.

B. EducationakBackground (Check highest degree.) /7 -_

/7

I-BA/BS ( ) 4- LLBJJb ( )

2-MS /MA (" ) 5-PhD ( ).

--EdD . '.( ) 6-MD ( )

Major piscipljne: .. /7/7. _

.-.-C. Administrative Background (Check the one, area below that best--

describes your current role.) ''

17OrganizatiOn Administration ( )t

---__:____ 2-Program Administration ( )

I=Supervisor. of Administrative ,Support

_..._..._Service ( )s

4-Administrative Assistant.

5-Teaching Faculty ( )

6-Other (Please specify) ( )

A

t.

.f.

-68-

71

/7

. Administrative Experience (Please check only one.)

.

1-Less than 1 year ( )

2-1 to 2 years ( )%.

3-2 to 3 years ( )

4-3 to 4 years ( )

5-4 tue5 years (. )

8 -More than 5.years )

E. Age,(Please indicate your age in years.)

Age:

F. Organizational Base (Please check only one.)

1-University-Public ( )

2-University-Private ( )

3-Nonprofit Publi-c ( )

4-Nonprofit Private )

5-Federal-Government (

6-State Government ( )

7 -Local tovernment ( )"

G. NuMber of Employees inYour Program (Not applicable forteaching faculty and Federal governmental program staff.)

1-Professional Personnelp

2- Support Personnel

H. NuMebo-of Clients Served by Your Program Annually (Please

check only one. Not applicable for teaching faculty and

Federal governmental program staff.). .

1-Less than, 100 (. ) 7-1001 to 1500 ( )

it-

2-101 tO 200 ( ) 8 -1501::t02000 )

3-201 to'300 )9-2001 to 3500 ( )

4-301 to 400 ( )

oo.e

10-2501 to' ( )

5-401 to 500 ( ) 11-More than s000L_I )

6 -501 to 1000 - ( )

-69 ,

12.

r

/7

G/7

/7

CiargaL7L7EICI

aL7

I. Operating Budget - Current Year (Please check only one. Notapplicable for teaching faculty and Federal governmental'

',program staff.),

1-Less than $250,000' ( ) 10-$1,500,001 to 2,000,000 ( 4

2-251,000 to 300,000 ( ) 11-2,000,001 to 2,500,000 ( )

3- 301,000 to 350,000 ( ) 12-2,500,001 to 3,000,000 ( )

4-351,000 to 400,000 ( ) 13-3,000,001 to 3,500,000 ( )

5-401,000 to 450,000 ( 14-3,500,001 to 4,000,000 (

6-451,000 to 500,000 ( ) 15- 4,000,001 to 4,500,000 ( )

7-501,000 to 1,000,000 ( 16-4,500,001 to 5,000,000 ( )

8-751,000 to 1,900,000 ( ) 17-Mori, than.5,000,000 ( )

9-1,000,001 to 1,500,000 "( )

F!. HEALTH SERVICES ADMINISTRAT4N MANPOWER AND STATUS NEEDS

A. How many administrative positions do you currently have inyour orgahization that require a doctorate?

B. How many administrative positions db-y rctrryour organization that.require.a'masters degree?

C. How many adminiStrative positions do you currently,have inyour organization that require 4-bachelors degree?.

D. Does your program plan towincrease thenumbet of adminiitrativepositions in the next 2-5 years?

1-Yes ( )

.2 -No ( )

. 3-Do not know ( )

E. If yes to the above question:

How many bachelor positions?.

How many masters positions?

'How many doctoral positions?

7.3

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17/7

.

4

RESPONSIBILITIES FOR ADMINISTRATORS. In this' section of the

questionnaire we are trying toAetermine what role and degree..the administrator should play in the major fundtional areas of

management .for health services programs. Please circie,,the number

that represents the degree to which you feel-an administrator

should be involved in the major functional areas of managementsystems that-are listedbelow.

A. Principles of Organization and Management

1) Organizational Planning

1 2 3 5

Never - Sometimes Always

.2) Program Planning

1 2 3 4 5

Never Sometimes Always

3) Decision MakinV

;

1 2 3 4 5

Never. Sometimes 1 Always

4 Polky"taking

.

2.'3 5 ,

-Never Sometimes Always

B. Organizational Development

1) Nature, and Purpose of Organization

1 2 3 4' 5

Never Sometimes AlWays

2) Scope of Management Authority

1 2. 3 4 5


3) Assignment of Activities

1 2 3. 4 5


4) 'Determination of Line -Staff Relationships

- -1 2 , 3 4 5


5) yrovisionotSupport Services

1 3_ 4 5


-7 1 -

z-

/7

/7

/7

L7

Structuring of Zommittees

1 2 3 4 5


C. Personnel

1) Personnel Administration

1 2. 7 3 . ' 4 5


2) Recruitment-Procedures -

1 2 3 4 5'

Never, Sometimes Always

3) Supervision and Training

', 1 2 3 4 5

Never Sometimes ' Always

r.

4) Performance Evaluation and Promotions

1 2 3 . 4 5


5) Employer-Employee Relationship

1 2 3 4 . 5


D. Direction and Communication

1) Communication- of Organizational,Goals

1 2 3 4 5

Never-- Sometimes Always

2) Facilitate Communication within the Organization (Formal

and Informal)

1 2 3 4 5


3) ComMunication with the Media.

1 2 3 5Never Sometimes Always

4) Public Relations Communfcation

1 2 3 . '4 , 5

Never Sometimes' Always

OP

/7

/7

/7

/7

/7

/7

L/

5) LAdership within the'Organization

1 2 3 . 4 . 5

Never Sometimes . Always

6) Leadership Outside.the Organization.

1 2 3 4 5


E. Controlling

1)^ Program Operations

1 2 3 4 5

Never Sometimes' Always

2) Organizational Operations

1 2 3

Never Sometimes

3) Policies Development-

5

Always

. .

1 2 3 4. 5-

Never Sometimes Alwfays

4) 'Support Systems

1 2 3 4 5

Never t* Sometimes Always,

5) Ptrsonnel System' t

1 2 . 3 4 5

Neve'r Sometimes Always

6) Financial System

1 2 3 4,t;. 5

Never .Sometimes Always

F. F4nancfal Develbpment and'Accounting

1) Basic Organizational.Budgeting

1 2 .3

Never

Program Bqdgetitig.

-' 1 . 2 ' 3 4 '5


"'

Sometimes4. 5

Always

-73-

/7

/7

/7

/7

/7

L7

'.

/7

Basic Organizational Accounting

1 2 3 4 5


4) Individual Program Accounting

1 2 3 4 5

,Never ' Sometimes 'Always

5) Funds Development r Federal Government

1 2 3 4 5

Never Sometimes Always '

- 6) Funds. Development - State Government

1 2 .3- 4

Never Sometimes

7) Funds Development - Local Government

1 2// 3 , 4

Never Sometimes

5-

Always

8) Funds.DevelobMent - Labor and Industry

1

Never

',4) Third Party Payment,

2 _3 4

1

Always

--

1 2 3 4 I

//5

Never Sometimes -Always__

10) User Fees Development/Collection

2 .3

Never Sometimes

11) Philanthropy

1 2 3'

Never Sometim4,

G. Economics and Cost Analysis

.1) 'Cost Benefit Analysis

1,, 2 -, 3

Never. Sometimes

77-74-:

5/ATiays

4

5

Always

5

Always

//

/7

/7

/7

s

'4

2) Manpower Development

1 2 3 '4 5 -

.Never Sometimes '.,-

Always

3) Impact of-Economic Factors on the Supply of Developmental

Disabilities Services

1 2 3 4 5


4)- 'Relationship between Economic Status and Need for.

Developmental Disabilities Services

1 2 3 .4 5


H. External Organizational Relationships ,-

1) Program Relationships with Federal Government

1 2 3 4 :5Never Sometimes Always

-- 2) Program Relationships with State Gove;belft

1 2 3 4 ' 5

Neveri

Sometimes Always

3) PrograIh Relationships with Local Government-4.." 4 r:

1 2 3 4 5


4) Program Relatidnships with Other Agencies

1 2' 3 4 5


5) Departmental. Relationships within the Parent Organization

1 2 3 4 , 5

Never SometiMes Always

'6) Legal Iftlications Related to'Developmental'Dis-abilities Services

1 2. 3 4 . 5Never Sometimes Always'

7) Polfttcal Matters Related to Developmentalabilities Services

2 3. ,- .5 .

, Never. Sometim4 -Always

4

.

7

/ 7

/7.

C .

Ir

1

1

I

a

I. Management Information System

1)

2 3, 4 5Never Sometimes

/Always-

. ,.

2) Development of Policy onthe Use andConfidential Information

Development of Record Systems

1 2 3 4 -5Never Sometimes Always

3) COmputer and Technology ofInformation

2 3 4 ,.4 5


4) Opgrationai Responsibility of Data Processing SysteMs,,

1 2, '3 4- 5Never Sometimes 4 Always

J; Health Care Delivery Systems

1) Integration of Developmental Disabilities Program withCommunity

$

1 2 3. 4 5,., , Never Sometimes . ) Always

2) Liaison Relationship with Community Health' gencies

1 , 2 3 4 , 5Never- Sometimes ' Always,

_ 14.

'I.

3 ''Represents the Organization or Program to thelkommunity

1 '.2 3 4 5Never Sometimes Always

4) Determines and Identifies Community Needs

1 2 3 4 5Never Sometimes Always

5) Determines Community, Resources for. Developmental pis-abilities Services

1 2- J-- 1.' 5Never Sometimes Always

6) Determines Types and Extent of Evaluation Services foreyelopmental Disabilities

.

1 ',' 2 3 - 5'


-1

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/7

/(-

- --

Please add additions topic areas that you think an, administrator

should play and nate thedegree on a scale of 1 - 5.

Area:

1

Never-

Area:

2 4Sometimes

'5

Always

1

Neverv.

A-rea:

3

4,Sometimes

4 5,

Always

1

Never

2 3

-tometimes

4 5

Alwyas

,' Your assistance in tompleting this qyestionnaire is greatly appreciated

A and will be very helpful in determining.the basis for a curriculum

program in multidiscipline health services administration.

/7

Li

777-,

iii)

'4

QUESTIONNAIRE RESPONSE SUMMARY

_ Groups Mai led

Directors -. UAF & MR Centers 50

, Administrators - UAF'& MR Centers47

Coordinatori.State Programs of MR 53 .

Governmental Staff 22

Graduate Program Directors 38

Community D. D. Directors 106 .

TOTAL 316

'DEMOGRAPHIC DATA

I. Group Characteristics

A. 'Academic. Background

Groups

Di rectors - UAF &MR Centers,

Administrators` - UAF &MR Centers

Coordinators State Pro-grains of MR .

`Governmental Staff

Graduate Program Directors

Community D. D. *Di rectors

JOTAL

BA /BS

Received Returned

27 54

30 64,

26 49.

16 73

24 63

47 44

170 54

MS/MA Ed) PhD MD

Bondi ng # % .% # % # %

27 4

.

14 311 9,-;

12 44!

30 8'27' 18 60 '1 2

.33

$6 -- 2 8 , 15 58 . 727

/ 16 ) ' 11 69 1 19

v23

*. ''lI

1 4 3

.1

13- 16 70 2 9

.51,1 511. 28 60 4 8 4 8 5,11

: ,16 16.9 1941. 8 ,41 24 - 21 12

* One person indicated 'no degree:-78-

,

,

I

B. Admini§tratiye fxperjeTice

Groups

Di rectors - UAF &MR Centers

Admi ni t4# to rs' U` &.MR Centers-

Coordinators State Pro=grams of,,MR

Governmental Stiff

Graduate Program Director§

Commun'ity D. D. Directors ..

TOTALr.

C. Age

Years

<1 . 1-2 2-3° 3-4- 4-5.# % d % # #. % # %

>5#

r 4

s "0

s 4

.

rf .

-'i

25 93

, 1 3

.

3 10

.

10' 23 77

1 . 4

--,

1 4 2 8 21 80. -

, 1 6 1594

2: 4 ' 1 4 15'4 2

1 2 3 6 6 13

....

4 .

.-

9.- , (3,,. .6-

_19.83

-14644

2 21 5, 3 10_ 6 8-5, 11'

,

6 133 7

Groups, . .

Di rectors t- UAF ItMR tenter; .

Admiliistrators - U4F &MR Centers

"COordinatcfrsAtate Pro-graMs of KR-7'

; Governmental 'Staff ,

Graduate Program Directors4

'Community D." D. ofrectorss

e

'I

.

".

82

.'^ 42'5

,541

50

'41

N

0

Years

Range

30-.59

,29-6tit

28-58'*

31-59

,27,64

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.-

1:1.

16

1,32

071

5462

9.1,

865

.2.4

2:1

2,61

3'31

5 94

469

8,55

71:

2.28

,

11,9

42_3

0-

..1

2813

54.7

0'.

40;2

961:

2.31

A.,.

.*r

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s --

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tlien

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t ,

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200

#% 13

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401-

500

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1-10

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1001

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1501

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Di '

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ors

- O

F_

AM

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f...

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Adm

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trat

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- U

AF

"

,g M

R C

ente

rs,

'

Coo

rdin

ator

s S

tate

'..P

rogr

ams

of M

R

.Cur

miu

nity

D. D

.D

i rec

tors

3

101

310

13'

37

235

17'4

14

41

42-

84.

2

49

9

!--

64

95

3'6

36

a.

tr

r"

2001

-4

2501

-

2500

5000

>50

00#

%:

-0%

#%

313

29

310

'10

312

r 416

1104

6"2

46

13

' "1'f

0. O

pera

ting

Sodg

ot.;

12

34

4

NN

6'7

\

N.

011

1213

SA

15

16

tt

Ailif

01 r

ecto

rs -

Uff

6N

I C

anto

rs

Ado

lnis

trat

Ort

- U

AF

11 M

t Gal

lon

Coo

ina

Stat

erd

ams

oftors

MI

Prog

r

Can

ism

ity.D

. D.

al r

ecto

rs

.

4 1 1 S

-

16

3 4 11

2 2

' ..

1

_ 6 7 2

1 3

4 62

5

I II

11=

46

6

102 1. M

I7 4

112D5 11

.,3

20 6

1 2 3

4 7 6

2 1.11

11

111

21

2

11

s

1r,

, J1;

i13

4T

S63

-619

1

rt

I

, 1.

1-L

oss,

than

$25

0.00

0

2-25

1.00

0 to

300

,000

3-30

1.00

0 to

350

.000

.4-3

51.0

00 w

ibo.

soo

.6-4

01.0

00 to

450

,000

6-41

1.00

0 to

600

.000

-7-

501.

000

to 4

400,

000

6-76

1.00

0 to

1.0

00.0

00

5-1,

000.

001

to 1

400.

000-

.4t

1041

.500

.001

to 2

.000

,100

0

11-2

.000

.001

to 2

.500

.000

12-

2.50

0.00

1 to

3,0

0003

00

13-3

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.001

to 3

.500

.000

14-3

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.001

to 4

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.000

15-4

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401

to 4

400.

0010

16-4

.500

.001

to 5

,000

,000

17-1

4ore

than

5.0

00.0

00

.

,J

I

Administration Manpower and Status

Need Curren t Posi ti

Group s.

Doctorate

Masters

.Bachelor'

#%

1 S

Directors - UAF & MR Centers

Administrators - UAF -& MR

Centers

coordinators State Programs.

Governmental Staff

Graduate Program Directors

Communi

Di rectors

TOTAL

..;

4

New Positions

.

Doctorate

Masters

Bachelor

#' %

#%

#

98

15

.122

18

438

67"

'27

75

514

411

65

44

38

25

.47

31

.4

17

13

54

,.7'29

,

143

'5.

S74

20

2154

75

95

191

60

58

35

,6

1224

59

229.

229

342

.12.-29

43

62)6728

502

g6

10

77

3

258

21

29324

662

55

15

11

43;3

80

58

619.11

1248

22'

,3827

67

..4r-

67

17

'167,4

152

40

4.- 7

4

t,

0-a

-.

.

*.

.:4-

1 VariOlps-

;Djrectors

Admini:!,

....,..

-;

,.Organigkti,o4Al Planning

- 4.63 -

4.37

.0

...-

_,-. \

-,-,

-Pkogram. Planning,

3:81'

3.97

3.%8

'4.33'

O.

.-

#--

.,

.

Dec isi9n

rzal

tirtg

'

P9licy 'Making

,4.

114:

40A

, . 4'''.

..--

4-

- -

Ilitu

rean

d Pu

rpos

e of

-..;:

..

s.Organization

,4.

2641

404.

31.

..

AA

. I*S

cope

of

Iian

ager

tn t

,.

Aut

tiori

ty,

4.15

.4.1

574.

04I

.O

..k

/

CO

; fe

,,,.

Mis

ignm

ent :

:f ,

Aci

iviti

es3.

524.

103.

6541

4-t

,-.

Dat

erra

in2i

tion

of ti

ne-

Staf

f -R

elat

ions

hip

3.81

-,4.

373.

83.i_

,,,

Prov

isio

ns o

f Su

ppor

t-

..-

-Ser

aces

:`4.

154.

703,

15

. 4St

ruct

urib

g\of

(C

iam

mitt

es,

3.37

3.67

3.19

,,

INorbonsmil.Administratibn

4.11

.

4.83

3.27

:

-p-,

,

.'fticrUitmeat PrOcedAte*

-4.6

04.43

2,92

.

I 7.

;POMP 9PANfl

Co/9rd.

state Prog.

4.53

4.00

4.19

4.58

.

c,rad. Prog.

Gov't Staff

tirectors

.1.6p

4.25

4.62

4.25

4.31

4.71

4.25

4.33

4.42

4.42

4.56

4.12

,

3.94

3.58

,

3..8

73.

92

3,81

3.46

*_

3.50.

3.46

k79

,3.21

.3.69

2.92

..

.

..'A

I,

6.(

I.

i'

I

R..- Values below

the.

0.0

5lev

el in

dica

tes

significant

';gro

upmean differences

.

1

Commun.

D.D. Dirs.

P

4.70.

4.0000

4.09

1,0100

4.28

0.0426

,4.47

1.1000

4.57

1.0000

0.114G

0.0927

3.96

Q.3837

380.000b

3:36

1:0000

3.72

calm

3.36

0.0000

-GROUP MANS

Variables:

(

Directors

Adminis,

Coord.

State Prog.

'Gov't Staff

Grad. Prog.

nirectors

.

D.D.

Commun.

Dirs.

4

Supervision & Training

.3.26

3.83

:3.27

3.37

2.87

,3.49

0.0103

Performanc

Evaluation

Prometio

3.93

4.07

3.62-

3.75

3.50

3.55

0.1745

-, Employer -Em loyee

Relationship

4.26.

4.60

3.85

4.12

3.54

3.81

0.0012

Cdmmunication of

Organizational Goals

4.07

4.27

4.19'

4.50

4.50

4.36

1.000o

Facilitate Communication

O

Within Organization

4.11

4.40

3.88

4.00

4:12'

4.19

0.3885,

Communication With Media

3.41

3.57

3.58

3.25

3.46

3.64

1.0000

.Public Relations

Communication

3.33

3.57

3.58

3.25

3.25

low

3.79

.1338

Leadership Within

Organization '1

4.22

4.43

4-46

4.00

4.37

4.47

1.0000

Leadership Outside,

The'OrganizatiOn

s.

3.67

3.87

3.92 .

,3.50

4.21

.

,.3:79

0.3056

Program Operations

3.10

3.73

3.31

-3.37

Au

3.5a

3.47

1.0000

Organizattonal Operations

3.81

4.53

3.73

3.62

3.71

3.98

.0.0071

Policies Development

3,70

4.33,,.

4.23

3.94

4.17

4-.17

0A213

....P -'Valties below the` 0.05 level. indicates

significant group Olean differences:

L0

.

.f.

.1

4i,

-.4:

.

,

,-,

W $04-

.

'."

Variables'

Directbrs

Adminis.

GROUP' MEANS

.

Gov't Staff

Grad. Prog.

Directors

,

Commun.

D.D. Dirs.

'P

Coord.

State Prog.

Support Systems

.*

''

-4.11*,

..

',personnel System

4.14

-Finshbial System

4.52

t.4

er

asiC OrginizatiOnal.

.

.:-

.

audgetin

,.

4.52

.,

,

Ppgrapluddiiting'

.4.41

:J

l'a

./.

Prbgram Re

bnships

Witb'StWtOpe

vernitent

;3.0

Witte

Program el ion hips

-

'With Local,

ver

ent

'3.67. .

.,

,,,Program

i.

With Other RgemCies

3.63

..

..

.;

:Dept, Relationships

'.

Within The Parent Organiz.

3.70

..

Legal Implicatidti Related-

TO;O.D. Services;

3a81

,..

'

Political Matters Related

Tc D D% Servioes'..

1r 3.37'

'

4.77

.

-4.67

q''.

4.83

,

4>83

4,6i -,

4%.-07s

3 97

.t

,

3.93 1

4.10

c -

4.20

i4.00

."-

\,, .

.

A

.

3.08

,3.00

3.65

3.65

3.1.2.

,4.15

.

3.69

.3.81

.

-3.77 .

4

3.85

3.88

,- ! ' ..

,

.

3.75

_

3.81

4.19

/

4.06

C.19

3.81

3.69

.-

3.62

3.81

3.62

0

3.44

.

4.

.

3.29

.

3.46

;

4.00

3.96

3.92

,

_ 3.75

3.75

.

3.67

3.75

3.62

3.62

.'

...

I,

'3,34

..

3.45

4.13

4.23

4.04

a,

4.04

....,

3.72

3.81

.

,4.04

4.02

3.83

'

.0.0000

_0:0000

0.0005

0,0033

0.0035

1.0d00

)

1.0000

1.0000

1.0000

043606-

0.3146

,c

q.

.-

,

...IP

6...-

.

4.P.

- V

alue

s .b

elow

ttie

0.0

5 W

el in

dica

tes

.

Significant group;mean differences.

,e

.

Vari4bles

Directors

4.

Adminis.

GROUP MEANS

Gov't Staff

Caord.

State Prog.

Developilent of Record

System

4:22

4.47

3.12

3.69

Devel. of POlicy-use

Abuse of Confidential Info.

4.63

4.87

4.58

.4.69

Computer Technology of Infor.3.81

3.97

4.00

4.25

Operational Responsibility

Of Data Processing Systems

3.78

4.33

4.19*

4.62

Integration of D.D. Pro-

grams With Community

4.11

4.40

4.58

4.25

14.dison Relationships With

Community Health Agencies

4.26

4.40

4.31

4.31

Represents The Organiza-

tion or Program to Commun.\

1.15

4.67

4.04

4.56

Basic Organizational

Accounting}'

04.73

2.31.

3.50

Individuhl Program

Accounting

4.11\

72.12

3.37

MeveloPment-

.I

_FUnds

Federal Government

4.33

\4.47

3.50

4.06

Funds Developmtnt-:

State Government

4.41

4.53

3.8i

4.06,

P - Values below the 0,05 Level

indicates

Significant group, mean differences.

Grad. Prog.

Commun.

Directors

D.D. Dirs.

P

2.96

3..68

0.0000

4.71

4.79

1.0000'

-4.25

4.33

4.42

4.42

4.12

2.54

1.42

3.75

3.67

4.09.

1.0000

4,28

0.0426

4.47

1.0000

4.57

1.0000

4.21.

0.1146 -N.

3.04

0.0000

2.87

3.91

0.0000

0.0051

0.0177

Variables

:.FUndi Development-:

Government

4.22

iinds Development-

..

Lab0r 6 Industry

3.85

4.20

Directors

Adminis.

4.30

Arty

Payment

7'

User Fees Development/

4.07

4.63

Collection

3.74

4.40

'`.

..

Philanthropy

3.63

Cosejishefit Analygis

.4.41

co

1

co,

._ .

.I

1Mangog*er Development

.:

3.63

_ .,Impact on-Economic Eadtors

on the Supply of ,D.D. Srvs. ,3.70

,-

.

-RelationshipmEconomic

..,

9..:Status-geed for D.D. Srvs.

3.5

Program Relation hips)

..

With Federal Government!

t

L81

_Determines 6 Identifies

1

.,

C6mmuniiy Needs

,3.52

...'

P'

,.

..

''P - Values below thi 0,05 level .indicates

1significant group mean differences.

3.93

4.63

4.13

4.23

4,23

4.07

4.10

tj-

i C1

0

GROUP MEANS

COord..

-Grad. Frog.

Commun.

State Prog.

Gov't Staff-

Directors

D.D. Dirs.

3.08

2.81

.77

4.06

4.06

3:81

2.50

1.56

2.62

3.44

3.00

4.06

3.15

3.44

3.38

3.6%

1.-46

3.44

3.81

3.65

3.94

3.67

3.62

3.50

2.87

3.71

3.67

I3.54

----

.c

3.17

2.83

_

.3.71

3.58

,

\ 3.72

0.0016

3.32

0.0004

3.19

0.0000

2.83

0.0000

3.15

0.0009

3.81

0.0000

3.60

J3-0480.__

3.79

0.0333

-

3.60

0.0060

3.68

1.0000

3.60

0.0927

7 4,

''.a

,'COord.

Glad. Proq.

'46mmun.

,

variables

Firectiors

,Adminis.'

State Prog.

Gov't Staff

''

Directors

. JD.D.,

Dirs.

"GROUP MEANS

.-40.--

'Determines COmmun.

,

Resources for D.D. Srvs.

3.81

'-=Determines Types & Extent

,Of,Evalua...Srvs. for D.D.

4

4.15

I

4.37

3.88

3.87

3.92

3.96

'

0.3887

4:70

3.15

,1.81

.3.46,

3.38

o.od6o

- Values below the 0.05 level indicate

significant group,mean differencei».